2型糖尿病合并血流感染的病原菌分布及耐药性分析
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摘要
目的分析T2DM合并血流感染的病原菌分布及其药敏特征,为临床早期诊断及选用抗菌药物提供依据。方法回顾性分析2009年1月至2014年12月66例T2DM合并血流感染病例的临床资料,并进行比较。结果入选病例共培养分离出病原菌66株,其中,革兰氏阴性菌47株(71.2%)、革兰氏阳性菌19株(28.8%);革兰氏阴性菌以大肠埃希菌(19株)和肺炎克雷伯菌(16株)为主,产超广谱β内酰胺酶(ESBLs)菌检出率为29.8%;感染部位以呼吸道(23例)、泌尿道(17例)及胆道(11例)多见;多数革兰氏阳性菌属对青霉素及氨苄西林耐药率高,对万古霉素和替考拉宁敏感性高;大肠埃希菌及肺炎克雷伯菌对氨苄西林耐药率分别为68.4%及100%,对亚胺培南和美罗培南敏感性为100%。结论 T2DM患者合并血流感染病原菌以革兰氏阴性菌多见,主要为大肠埃希菌及肺炎克雷伯菌,临床应结合血培养结果合理选择抗菌药物。
Objective To study the pathogens distribution and antimicrobial resistance in type 2 diabetic(T2DM)patients complicated with bloodstream infections,and to provide the basis of early diagnosis and rational use of antibiotics. Methods 66 T2DM patients complicated with bloodstream infections from January 2009 to December 2014 were retrospectively reviewed. Results A total of 66 clinical isolates were collected from the blood samples,of which gram negative organisms and gram positive organisms accounted for 71.2% and 28.8%,respectively.Among 47 strains of gram negative organisms,in which 14(29.8%)strains were ESBLs-producing isolates,the main isolates were Escheriehia coli(19 strains)and Klebsiella pneumoniae(16 strains).The top three primary infection sites were respiratory tract(23 cases),urinary tract(17 cases)and biliary tract(11 cases).Most of gram positive organisms were high resistant to penicillin and ampicillin while sensitive to vancomycin and teicoplanin.The resistance rates of Escheriehia coli and Klebsiella pneumoniae to ampicillin were 68.4% and 100%,respectively.No imipenem or meropenem resistant strains of Escheriehia coli and Klebsiella pneumoniae were found. Conclusion Gram negative organisms were the main pathogens in T2DM patients complicated with bloodstream infections,especially Escheriehia coli and Klebsiella pneumoniae.Blood culture and drug sensitive test should be considered before clinical use of antibiotics.
Objective To study the pathogens distribution and antimicrobial resistance in type 2 diabetic(T2DM)patients complicated with bloodstream infections,and to provide the basis of early diagnosis and rational use of antibiotics. Methods 66 T2DM patients complicated with bloodstream infections from January 2009 to December 2014 were retrospectively reviewed. Results A total of 66 clinical isolates were collected from the blood samples,of which gram negative organisms and gram positive organisms accounted for 71.2% and 28.8%,respectively.Among 47 strains of gram negative organisms,in which 14(29.8%)strains were ESBLs-producing isolates,the main isolates were Escheriehia coli(19 strains)and Klebsiella pneumoniae(16 strains).The top three primary infection sites were respiratory tract(23 cases),urinary tract(17 cases)and biliary tract(11 cases).Most of gram positive organisms were high resistant to penicillin and ampicillin while sensitive to vancomycin and teicoplanin.The resistance rates of Escheriehia coli and Klebsiella pneumoniae to ampicillin were 68.4% and 100%,respectively.No imipenem or meropenem resistant strains of Escheriehia coli and Klebsiella pneumoniae were found. Conclusion Gram negative organisms were the main pathogens in T2DM patients complicated with bloodstream infections,especially Escheriehia coli and Klebsiella pneumoniae.Blood culture and drug sensitive test should be considered before clinical use of antibiotics.
引文
[1]刘泽林,付茂,傅祖植,等.糖尿病并发肺部感染患者免疫功能变化及其影响因素研究.中国糖尿病杂志,2003,11:139-140.
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[6]Koh GC,Peacock SJ,van der Poll T,et al.The impact of diabetes on the pathogenesis of sepsis.Eur J Clin Microbiol Infect Dis,2012,31:379-388.
[7]Peleg AY,Weerarathna T,McCarthy JS,et al.Common infections in diabetes:pathogenesis,management and relationship to glycaemic control.Diabetes Metab Res Rev,2007,23:3-13.
[8]杨杰,王清,徐冬岩,等.糖尿病患者发生败血症病原菌分布及药敏性分析.中华医院感染学杂志,2013,23:5092-5094.
[9]张晓琳,焦红梅,刘新民.产超广谱β内酰胺酶对肠杆菌科细菌血流感染病死率的影响:荟萃分析.中国感染与化疗杂志,2013,13:93-99.
[2]宁永忠,叶红,张捷.2005至2007年北京大学第三医院血流感染的微生物学分析.中华传染病杂志,2009,27:161-166.
[3]Clinical and Laboratory Standard Institute.M100-S19Performance standards for antimicrobial susceptibility testing nineteenth informational supplement.Wayne Pennsylvania,2009,29:M02-A10.
[4]NICE-SUGAR Study Investigators,Finfer S,Chittock DR,et al.Intensive versus conventional glucose control in critically ill patients.N Engl J Med,2009,360:1283-1297.
[5]Stegenga ME,Vincent JL,Vail GM,et al.Diabetes does not alter mortality or hemostatic and inflammatory responses in patients with severe sepsis.Crit Care Med,2010,38:539-545.
[6]Koh GC,Peacock SJ,van der Poll T,et al.The impact of diabetes on the pathogenesis of sepsis.Eur J Clin Microbiol Infect Dis,2012,31:379-388.
[7]Peleg AY,Weerarathna T,McCarthy JS,et al.Common infections in diabetes:pathogenesis,management and relationship to glycaemic control.Diabetes Metab Res Rev,2007,23:3-13.
[8]杨杰,王清,徐冬岩,等.糖尿病患者发生败血症病原菌分布及药敏性分析.中华医院感染学杂志,2013,23:5092-5094.
[9]张晓琳,焦红梅,刘新民.产超广谱β内酰胺酶对肠杆菌科细菌血流感染病死率的影响:荟萃分析.中国感染与化疗杂志,2013,13:93-99.