阴沟肠杆菌血流感染的临床特点及耐药性
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摘要
目的了解阴沟肠杆菌血流感染的临床特点及耐药性,为临床合理用药提供参考。方法回顾性分析2012年1月至2016年12月该院分离阴沟肠杆菌血流感染的临床特点及耐药性,采用纸片扩散法或自动化仪器法进行细菌药敏试验,根据美国临床和实验室标准协会(CLSI)采用WHONET5.6分析菌株耐药率。结果由阴沟肠杆菌所致的医院获得性血流感染的患者共66例,原发性血流感染占12.1%(8/66),继发性血流感染占87.9%(58/66),继发感染与导管、胆道、泌尿道相关。基础疾病中以胆道结石、尿毒症及泌尿系梗阻多见。静脉穿刺针、深静脉置管、导尿管、透析管是血流感染常见的诱因。阴沟肠杆菌对头孢替坦敏感率为75.8%,对复方磺胺甲噁唑、氨曲南、妥布霉素、头孢三代、哌拉西林/他唑巴坦敏感率在80%~90%。对碳青霉烯类、阿米卡星、喹诺酮类、头孢四代、庆大霉素等抗菌药物敏感率在90%~100%。结论阴沟肠杆菌血流感染以继发性感染多见,临床分离到的菌株与侵袭性操作或手术高度相关,应加强医院感染控制;同时,积极送检微生物标本培养和药敏,依据药敏结果合理用药。
Objective To analyze the clinical characteristics and drug resistance of E.cloacae so as to guide the reasonable application of antibiotics.Methods The specimen sources and drug resistance of E.cloacae isolated from Jan.2012 to Dec.2016 were analyzed retrospectively.Susceptibility test was carried out using Kirby-Bauer method or automated systems and results were analyzed according to CLSI with WHONET 5.6.Results A total of 66 cases were collected with nosocomial bloodstream infections due to E.cloacae,including primary bloodstream infections(12.1%,8/66)and secondary bloodstream infections(87.9%,58/66).These infections were mainly associated with catheter,biliary tract and urinary tract.The basic disease was mainly the biliary stone,uremia and urinary tract obstruction.Venous puncture needle,deep vein catheter,catheter and dialysis tube were common inducing factors in bloodstream infection.The drug sensitivity rate of E.cloacae to cefotetan was 75.8%.Antibiotics which sensitivity rate was between 80% and 90% were sulfametho,azoletrimethoprim,aztreonam,tobramycin,The three generations of cephalosporin,pieperacillin-tazobactam.The rates to carbapenemes,amikacin,fluoroquinolones,cephalosporins,and gentamicin was between 90% and100%.Conclusion Most of the bloodstream infections caused by E.cloacae are secondary to infections.These infections are mainly associated with surgical and invasive procedures.Hospital infection control measures should be strengthened.Meanwhile,the clinicians should take full advantages of microbiological laboratory to profile the pathogens and their susceptibility patterns,which is crucial for rational use of antibiotics.
Objective To analyze the clinical characteristics and drug resistance of E.cloacae so as to guide the reasonable application of antibiotics.Methods The specimen sources and drug resistance of E.cloacae isolated from Jan.2012 to Dec.2016 were analyzed retrospectively.Susceptibility test was carried out using Kirby-Bauer method or automated systems and results were analyzed according to CLSI with WHONET 5.6.Results A total of 66 cases were collected with nosocomial bloodstream infections due to E.cloacae,including primary bloodstream infections(12.1%,8/66)and secondary bloodstream infections(87.9%,58/66).These infections were mainly associated with catheter,biliary tract and urinary tract.The basic disease was mainly the biliary stone,uremia and urinary tract obstruction.Venous puncture needle,deep vein catheter,catheter and dialysis tube were common inducing factors in bloodstream infection.The drug sensitivity rate of E.cloacae to cefotetan was 75.8%.Antibiotics which sensitivity rate was between 80% and 90% were sulfametho,azoletrimethoprim,aztreonam,tobramycin,The three generations of cephalosporin,pieperacillin-tazobactam.The rates to carbapenemes,amikacin,fluoroquinolones,cephalosporins,and gentamicin was between 90% and100%.Conclusion Most of the bloodstream infections caused by E.cloacae are secondary to infections.These infections are mainly associated with surgical and invasive procedures.Hospital infection control measures should be strengthened.Meanwhile,the clinicians should take full advantages of microbiological laboratory to profile the pathogens and their susceptibility patterns,which is crucial for rational use of antibiotics.
引文
[1]马序竹,吕媛,郑波.卫生部全国细菌耐药监测网2011年血流感染细菌耐药监测[J].中国临床药理学杂志,2012,28(12):927-932.
[2]周庭银,倪语星,王明贵,等.血流感染实验诊断与临床诊治[M].2版.上海:上海科学技术出版社,2014:5-10.
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[6]李光辉,姚志文,林东昉,等.医院获得性血流感染395例临床分析[J].中华传染病杂志,2008,26(12):729-733.
[7]BLOT S,VANDEWOUDE K,DE BACQUER D,et al.Nosocomial bacteremia caused by antibiotic-resistant gram-negative bacteria in critically ill patients:clinical outcome and length of hospitalization[J].Clin Infect Dis,2002,34(12):1600-1606.
[8]夏静鸿,朱光发,王爱萍,等.重症监护病房患者血流感染的临床与病原学分析[J].中国感染与化疗杂志,2016,16(6):734-741.
[9]HILTY M,SENDI P,SEIFFERT S N,et al.Characterisation and clinical features of Enterobacter cloacae bloodstream infections occurring at a tertiary care university hospital in Switzerland:is cefepime adequate therapy[J].Int J Antimicrob Agents,2013,41(3):236-249.
[10]刘周,徐晨,姚杰,等.血流感染肠杆菌科细菌临床分布与耐药性研究[J].中华医院感染学杂志,2015,25(24):5559-5561.
[11]王凯.123株阴沟肠杆菌的临床分布和耐药性分析[J].中华医院感染学杂志,2013,23(1):187-189.
[12]林伯熹,李彬,刘秀琴,等.碳青霉烯类耐药阴沟肠杆菌耐药机制研究[J].中国感染与化疗杂志,2016,16(2):194-199.
[2]周庭银,倪语星,王明贵,等.血流感染实验诊断与临床诊治[M].2版.上海:上海科学技术出版社,2014:5-10.
[3]中华人民共和国卫生部.医院感染诊断标准(试用)[J].中华医学杂志,2001,81(5):314.
[4]DAVIN-REGLI A,PAGES J M.Enterobacter aerogenes and Enterobacter cloacae;versatile bacterial pathogens confronting antibiotic treatment[J].Front Microbiol,2015(6):392.
[5]丁娟娟,吕晓菊,宗志勇,等.阴沟肠杆菌血流感染52例临床分析[J].中国感染与化疗杂志,2007,7(2):116-118.
[6]李光辉,姚志文,林东昉,等.医院获得性血流感染395例临床分析[J].中华传染病杂志,2008,26(12):729-733.
[7]BLOT S,VANDEWOUDE K,DE BACQUER D,et al.Nosocomial bacteremia caused by antibiotic-resistant gram-negative bacteria in critically ill patients:clinical outcome and length of hospitalization[J].Clin Infect Dis,2002,34(12):1600-1606.
[8]夏静鸿,朱光发,王爱萍,等.重症监护病房患者血流感染的临床与病原学分析[J].中国感染与化疗杂志,2016,16(6):734-741.
[9]HILTY M,SENDI P,SEIFFERT S N,et al.Characterisation and clinical features of Enterobacter cloacae bloodstream infections occurring at a tertiary care university hospital in Switzerland:is cefepime adequate therapy[J].Int J Antimicrob Agents,2013,41(3):236-249.
[10]刘周,徐晨,姚杰,等.血流感染肠杆菌科细菌临床分布与耐药性研究[J].中华医院感染学杂志,2015,25(24):5559-5561.
[11]王凯.123株阴沟肠杆菌的临床分布和耐药性分析[J].中华医院感染学杂志,2013,23(1):187-189.
[12]林伯熹,李彬,刘秀琴,等.碳青霉烯类耐药阴沟肠杆菌耐药机制研究[J].中国感染与化疗杂志,2016,16(2):194-199.