113例成年尿源性脓毒症患者的病原学分布及耐药性分析
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摘要
目的分析尿源性脓毒症患者的临床特点及病原菌分布、耐药性特点。方法回顾性收集2006年至2016年北京大学第一医院确诊为尿源性脓毒症的113例病例资料,对患者临床特点及病原学分布、耐药性特点进行统计分析。结果 113例尿源性脓毒症患者平均年龄(67. 3±16. 5)岁,男性患者45例(占39. 8%)。院内获得性感染34例(占30. 1%),总死亡率12. 4%。血培养分离113株病原菌,革兰氏阴性杆菌98株(占86. 7%),革兰氏阳性球菌4株(占3. 5%),真菌11株(占9. 7%)。最常见的病原菌依次为大肠埃希菌75株(占66. 4%)和肺炎克雷伯菌13株(占11. 5%)。产超广谱β内酰胺酶(ESBLs)大肠埃希菌39株,占全部大肠埃希菌52. 0%,肺炎克雷伯菌产ESBLs 5株,占38. 5%;大肠埃希菌和肺炎克雷伯菌对亚胺培南敏感率均为100%,哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、阿米卡星敏感率均在84%以上。结论成人尿源性脓毒症患者血标本病原菌的构成以大肠埃希菌及肺炎克雷伯菌为主。定期开展医疗机构内的细菌耐药监测工作,对于指导抗菌药物合理应用及医院感染管理十分重要。
Objective To investigate the clinical features as well as the pathogenic organisms distribution and antibiotic resistance in adult urosepsis. Methods Electronic medical records of 113 adult patients with urosepsis were reviewed from 2006 to 2016 in Peking University First Hospital for collecting and analyzing associated information of the clinical and pathogenic organisms features. Results The average age of these patients was( 67. 3 ± 16. 5) years. Forty five patients( 39. 8%) were men. Thirty four cases( 30. 1%) were with hospital-acquired urosepsis. The total mortality during the hospitalization period was 12. 4%.Among the total 113 isolates from blood cultures,gram negative bacilli were the main pathogenic organisms( 98 strains,86. 7%). The isolate rates of gram positive cocci( 4 strains) and fungi( 11 strains) were 3. 5%and 9. 7%,respectively. The most common organisms of urosepsis in the study were Escherichia coli( 75 strains,66. 4%) and Klebsiella pneumonia( 13 strains,11. 5%). The rates of extended-spectrum-β-lactamases( ESBLs) producing strains of Escherichia coli( 39 strains) and Klebsiella pneumonia( 5 strains) were 52. 0% and 38. 5%. Escherichiacoli and Klebsiella pneumonia were highly sensitive to imipenem,piperacillin-tazobactam,cefoperazone-sulbactam and amikacin. Conclusion In this study,Enterobacteriaceae were mainly isolated strains,especially Escherichia coli and Klebsiella pneumonia. It is important to monitor bacteriological prolife and drug resistance pattern for rational use of antibiotics and hospital infection control.
Objective To investigate the clinical features as well as the pathogenic organisms distribution and antibiotic resistance in adult urosepsis. Methods Electronic medical records of 113 adult patients with urosepsis were reviewed from 2006 to 2016 in Peking University First Hospital for collecting and analyzing associated information of the clinical and pathogenic organisms features. Results The average age of these patients was( 67. 3 ± 16. 5) years. Forty five patients( 39. 8%) were men. Thirty four cases( 30. 1%) were with hospital-acquired urosepsis. The total mortality during the hospitalization period was 12. 4%.Among the total 113 isolates from blood cultures,gram negative bacilli were the main pathogenic organisms( 98 strains,86. 7%). The isolate rates of gram positive cocci( 4 strains) and fungi( 11 strains) were 3. 5%and 9. 7%,respectively. The most common organisms of urosepsis in the study were Escherichia coli( 75 strains,66. 4%) and Klebsiella pneumonia( 13 strains,11. 5%). The rates of extended-spectrum-β-lactamases( ESBLs) producing strains of Escherichia coli( 39 strains) and Klebsiella pneumonia( 5 strains) were 52. 0% and 38. 5%. Escherichiacoli and Klebsiella pneumonia were highly sensitive to imipenem,piperacillin-tazobactam,cefoperazone-sulbactam and amikacin. Conclusion In this study,Enterobacteriaceae were mainly isolated strains,especially Escherichia coli and Klebsiella pneumonia. It is important to monitor bacteriological prolife and drug resistance pattern for rational use of antibiotics and hospital infection control.
引文
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[6]NIEUWKOOP C V,BONTEN T N,VAN’T WOUT J W,et al.Risk factors for bacteremia with uropathogen not cultured from urine in adults with febrile urinary tract infection[J].Clin Infect Dis,2010,50(11):69-72.
[7]TANDOGDU Z,BARTOLETTI R,CAI T,et al.Antimicrobial resistance in urosepsis:outcomes from the multinational,multicenter global prevalence of infections in urology(GPIU)study 2003-2013[J].World J Urol,2016,34(8):1193-1200.
[8]ROTTIER W C,AMMERLAAN H S,BONTEN M J,et al.Effects of confounders and intermediates on the association of bacteraemia caused by extendedspectrum beta-lactamase-producing Enterobacteriaceae and patient outcome:a meta-analysis[J].J Antimicrob Chemother,2012,67(6):1311-1320.
[9]LEE J C,LEE N Y,LEE H C,et al.Clinical characteristics of urosepsis caused by extended-spectrum beta-lactamase-producing Escherichia coli or Klebsiella pneumonia and their emergence in the community[J].J Microbiol Immunol Infect,2012,45(2):127-133.
[2]RHODES A,EVANS L E,ALHAZZANI W,et al.Surviving sepsis campaign:international guidelines for management of sepsis and septic shock:2016[J].Intensive Care Med,2017,43(3):304-377.
[3]SCOTLAND K B,LANGE D.Prevention and management of urosepsis triggered by ureteroscopy[J/OL].Res Rep Urol,2018,10:e43-e49.2018-07-05[2018-09-05].https://dx.doi.org/10.2147/RRU.S128071.
[4]WAGENLEHNER F M E,PILATZ A,WEIDNER W,et al.Urosepsis:Overview of the diagnostic and treatment challenges[J].Microbiol Spectrum,2015,3(5):1-18.
[5]马序竹,郑波,李湘燕,等,成人血流感染的临床特点及病原学分析[J].中华医院感染病学杂志,2017,27(17):3860-3863.
[6]NIEUWKOOP C V,BONTEN T N,VAN’T WOUT J W,et al.Risk factors for bacteremia with uropathogen not cultured from urine in adults with febrile urinary tract infection[J].Clin Infect Dis,2010,50(11):69-72.
[7]TANDOGDU Z,BARTOLETTI R,CAI T,et al.Antimicrobial resistance in urosepsis:outcomes from the multinational,multicenter global prevalence of infections in urology(GPIU)study 2003-2013[J].World J Urol,2016,34(8):1193-1200.
[8]ROTTIER W C,AMMERLAAN H S,BONTEN M J,et al.Effects of confounders and intermediates on the association of bacteraemia caused by extendedspectrum beta-lactamase-producing Enterobacteriaceae and patient outcome:a meta-analysis[J].J Antimicrob Chemother,2012,67(6):1311-1320.
[9]LEE J C,LEE N Y,LEE H C,et al.Clinical characteristics of urosepsis caused by extended-spectrum beta-lactamase-producing Escherichia coli or Klebsiella pneumonia and their emergence in the community[J].J Microbiol Immunol Infect,2012,45(2):127-133.