老年患者血流感染病原菌的分布及耐药性分析
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摘要
目的了解广东地区血流感染(BSI)病原菌的分布及耐药情况,为临床合理用药提供依据。方法收集2013年1月1日至2016年12月31日广州军区广州总医院住院的1 199例疑似BSI老年患者血培养标本,共分离病原菌1 199株,采用全自动细菌鉴定仪对病原菌进行鉴定及药敏试验。结果 1 199株病原菌中革兰阳性菌489株,占40.8%;革兰阴性菌685株,占57.1%;真菌25株,占2.1%。位于检出率前5名的病原菌为凝固酶阴性葡萄球菌、大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌、金黄色葡萄球菌。病原菌主要分布在重症监护室(ICU)、干部病房和心内科。革兰阳性菌中耐甲氧西林金黄色葡萄球菌的检出率为48.3%,耐甲氧西林凝固酶阴性葡萄球菌的检出率高达88.6%。革兰阴性菌中的大肠埃希菌是BSI最主要的致病菌。2013-2016年,碳青霉烯类药物和替加环素耐药率整体呈直线上升趋势,万古霉素的耐药率逐年上升。结论广东地区老年患者BSI病原菌菌谱分布广泛,常见细菌耐药性仍较严重,临床应根据药敏结果合理选择抗菌药物。
Objective To understand the distribution and drug resistance of pathogenic bacteria of blood stream infection(BSI)in Guangdong,and to provide evidence for rational drug use in clinic.Methods A total of 1 199 strains of pathogenic bacteria were isolated from blood cultures of 1 199 suspected BSI elderly patients hospitalized in Guangzhou General Hospital of Guangzhou Military Region from January 1,2013 to December 31,2016.Pathogenic bacteria was identified and susceptibility test was carried out by automatic bacterial identification instrument.Results Of 1199 strains of pathogenic bacteria,489 strains were gram-positive,accounting for 40.8%,685 strains were gram-negative,accounting for 57.1% and 25 strains were fungi,accounting for 2.1%.The top five detection rates were coagulase negative staphylococcus,Escherichia coli,Klebsiella pneumoniae,Acinetobacter baumannii and Staphylococcus aureus.The detection rate of methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative Staphylococcus was 48.3%and 88.6%respectively.Escherichia coli in Gram-negative bacteria was the main pathogen of BSI.From 2013 to 2016,the drug resistance rates of carbapenems and tegacycline increased linearly,and vancomycin resistance rates increased year by year.Conclusion The spectrum of BSI pathogenic bacteria is widely distributed in elderly patients in Guangdong,and the drug resistance of common bacteria is still serious.Antibiotics should be reasonably selected according to the results of drug susceptibility in clinic.
Objective To understand the distribution and drug resistance of pathogenic bacteria of blood stream infection(BSI)in Guangdong,and to provide evidence for rational drug use in clinic.Methods A total of 1 199 strains of pathogenic bacteria were isolated from blood cultures of 1 199 suspected BSI elderly patients hospitalized in Guangzhou General Hospital of Guangzhou Military Region from January 1,2013 to December 31,2016.Pathogenic bacteria was identified and susceptibility test was carried out by automatic bacterial identification instrument.Results Of 1199 strains of pathogenic bacteria,489 strains were gram-positive,accounting for 40.8%,685 strains were gram-negative,accounting for 57.1% and 25 strains were fungi,accounting for 2.1%.The top five detection rates were coagulase negative staphylococcus,Escherichia coli,Klebsiella pneumoniae,Acinetobacter baumannii and Staphylococcus aureus.The detection rate of methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative Staphylococcus was 48.3%and 88.6%respectively.Escherichia coli in Gram-negative bacteria was the main pathogen of BSI.From 2013 to 2016,the drug resistance rates of carbapenems and tegacycline increased linearly,and vancomycin resistance rates increased year by year.Conclusion The spectrum of BSI pathogenic bacteria is widely distributed in elderly patients in Guangdong,and the drug resistance of common bacteria is still serious.Antibiotics should be reasonably selected according to the results of drug susceptibility in clinic.
引文
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[11]沈继录,潘亚萍,徐元宏,等.2005-2014年CHINET大肠埃希菌耐药性监测[J].中国感染与化疗杂志,2016,16(2):129-140.
[12]李耘,吕媛,郑波,等.中国细菌耐药监测研究2015-2016革兰氏阴性菌监测报告[J].中国临床药理学杂志,2017,33(23):2521-2542.
[13]李小四,范陈良,吴晓燕.嘉兴地区血流感染病原菌临床分布及耐药特性研究[J].中国抗生素杂志,2016,41(11):878-880.
[14]刘永芳,陈金文,周凤,等.血流感染病原菌构成及其多重耐药性分析[J].中国抗生素杂志,2017,42(12):1056-1060.
[15]张艳君,马秀珍,秦琴,等.血流感染病原菌的分布与耐药性分析[J].中国感染与化疗杂志,2017,17(3):314-320.
[16]张岩岩,朱婉,张静萍,等.多重耐药鲍曼不动杆菌血流感染危险因素分析[J].中国感染与化疗杂志,2017,17(2):134-139.
[17]李宏,郭丹,陈菁,等.2008-2014年中国南方某综合性医院血流感染病原菌构成及耐药性分析[J].中国抗生素杂志,2016,41(10):777-781.
[18]ZARKOTOU O′POURNARAS S,ALTOUVAS G,et al.Comparative evaluation of tigecycline susceptibility testing methods for expanded-spectrum cephalosporin-and carbapenem-resistant gram-negative pathogens[J].J Clin Microbiol,2012,50(11):3747-3750.
[19]HUANG TD,BERHIN C,BOGAERTS P,et al.In vitro susceptibility of multidrug-resistant Enterobacteriaceae clinical isolates to tigecycline[J].J Antimicrob Chemother,2012,67(11):2696-2699.
[2]查翔远,宋有良,金正胜,等.老年血流感染患者107例病原菌分布和药敏分析[J].中国感染与化疗杂志,2017,17(1):77-81.
[3]菅记涌,解泽强,全秀秀,等.血流感染病原菌分布及耐药性分析[J].中华医院感染学杂志,2017,27(3):535-538.
[4]刘德华,张红娟,杜艳,等.14 519例血流感染病原菌构成及耐药分析[J].中国抗生素杂志,2016,41(2):137-143.
[5]WISPLINGHOFF H,BISCHOFF T,TALLENT SM,et al.Nosocomial bloodstream infections in US hospitals:analysis of 24,179cases from a prospective nationwide surveillance study[J].Clin Infect Dis,2004,39(3):309-317.
[6]李小超.血流感染播散源头及病原学分析[D].唐山:华北理工大学,2017.
[7]STOJADINOVIC O,BREM H,VOUTHOUNIS C,et al.Molecular pathogenesis of chronic wounds:the role of beta-catenin and c-myc in the inhibition of epithelialization and wound healing[J].Am J Pathol,2005,167(1):59-69.
[8]TINEKE CK,CHEN WJ,BUNCK MM,et al.Metabolic changes in type 2diabetes are reflected in peripheral blood cells,revealing aberrant cytotoxicity,a viral signature,and hypoxia inducible factor activity[J].BMC Med Genomics,2015,8(1):20-35.
[9]WONG SL,DEMERS M,MARTINOD K,et al.Diabetes primes neutrophils to undergo NETosis,which impairs wound healing[J].Nat Med,2015,21(7):815-819.
[10]李晋华,车昌燕.产超广谱β-内酰胺酶肺炎克雷伯菌的临床分布及耐药特征[J].检验医学与临床,2017,14(6):788-790.
[11]沈继录,潘亚萍,徐元宏,等.2005-2014年CHINET大肠埃希菌耐药性监测[J].中国感染与化疗杂志,2016,16(2):129-140.
[12]李耘,吕媛,郑波,等.中国细菌耐药监测研究2015-2016革兰氏阴性菌监测报告[J].中国临床药理学杂志,2017,33(23):2521-2542.
[13]李小四,范陈良,吴晓燕.嘉兴地区血流感染病原菌临床分布及耐药特性研究[J].中国抗生素杂志,2016,41(11):878-880.
[14]刘永芳,陈金文,周凤,等.血流感染病原菌构成及其多重耐药性分析[J].中国抗生素杂志,2017,42(12):1056-1060.
[15]张艳君,马秀珍,秦琴,等.血流感染病原菌的分布与耐药性分析[J].中国感染与化疗杂志,2017,17(3):314-320.
[16]张岩岩,朱婉,张静萍,等.多重耐药鲍曼不动杆菌血流感染危险因素分析[J].中国感染与化疗杂志,2017,17(2):134-139.
[17]李宏,郭丹,陈菁,等.2008-2014年中国南方某综合性医院血流感染病原菌构成及耐药性分析[J].中国抗生素杂志,2016,41(10):777-781.
[18]ZARKOTOU O′POURNARAS S,ALTOUVAS G,et al.Comparative evaluation of tigecycline susceptibility testing methods for expanded-spectrum cephalosporin-and carbapenem-resistant gram-negative pathogens[J].J Clin Microbiol,2012,50(11):3747-3750.
[19]HUANG TD,BERHIN C,BOGAERTS P,et al.In vitro susceptibility of multidrug-resistant Enterobacteriaceae clinical isolates to tigecycline[J].J Antimicrob Chemother,2012,67(11):2696-2699.