骨科患者血流感染的临床特点及病原学分析
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摘要
目的分析骨科患者血流感染的临床特点及病原菌耐药性,为临床诊断和抗感染治疗提供依据。方法回顾性分析2012年1月-2017年12月北京积水潭医院骨科确诊血流感染患者的临床资料和病原学结果。结果 200例血流感染患者中男132例(66.0%),女68例(34.0%)。开放性骨折是引起骨科血流感染常见诱因。本组患者中单发伤62例(31.0%),多发伤89例(44.5%)。单一菌感染182例(91.0%),复数菌感染18例(9.0%);有基础疾病史患者55例(27.5%)。共计分离出218株病原菌,其中革兰阴性菌108株(49.5%)、革兰阳性菌91株(41.7%)、厌氧菌10株(4.6%)、真菌9株(4.1%)。前6位病原菌依次为凝固酶阴性葡萄球菌41株(18.8%)、大肠埃希菌27株(12.4%)、金黄色葡萄球菌23株(10.6%)、肺炎克雷伯菌19株(8.7%)、鲍曼不动杆菌14株(6.4%)及铜绿假单胞菌11株(5.0%)。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率分别为39.1%(9/23)和78.0%(32/41),未发现对万古霉素和利奈唑胺耐药的葡萄球菌。大肠埃希菌和肺炎克雷伯菌中超广谱β内酰胺酶(ESBL)的检出率分别为63.0%(17/27)和47.4%(9/19)。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感。鲍曼不动杆菌耐药性严重,对大多数抗菌药物耐药率大于80%。铜绿假单胞菌对氨曲南、阿米卡星、庆大霉素、环丙沙星和左氧氟沙星敏感率高,均≥80%。厌氧菌对哌拉西林-他唑巴坦和亚胺培南均敏感。念珠菌对5-氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑和伏立康唑均敏感。结论葡萄球菌和大肠埃希菌是骨科血流感染患者中最常见病原菌,应加强骨科病房感染防控措施,降低骨科血流感染的发生。
Objective To investigate the clinical characteristics and antimicrobial resistance of blood stream infections(BSIs)in orthopedic patients for appropriate clinical diagnosis and antimicrobial therapy. Methods The clinical data of the orthopedic patients with BSI from January 2012 to December 2017 were retrospectively analyzed in Beijing Jishuitan Hospital. Results A total of 200 cases were enrolled, including 132 males(66.0%) and 68 females(34.0%). Open fracture was the main predisposing factor of BSI in orthopedic patients, including 62 cases(31.0%) of single open fracture and 89 cases(44.5%) of multiple open fractures.Single microorganism infection was identified in 182 cases(91.0%), and multiple microorganisms mixed infection in 18 cases(9.0%).Underlying disease was found in 55 cases(27.5%). A total of 218 non-duplicate isolates were collected, including 108 strains of gram-negative bacteria(49.5%), 91 strains of gram-positive bacteria(41.7%), 10 strains of anaerobic bacteria(4.6%), and 9 strains of fungi(4.1%). The top six bacterial species were coagulasenegative Staphylococcus(41, 18.8%), Escherichia coli(27,12.4%), Staphylococcus aureus(23, 10.6%), Klebsiella pneumoniae(19, 8.7%), Acinetobacter baumannii(14, 6.4%),and Pseudomonas aeruginosa(11, 5.0%). The prevalence of methicillin-resistant S. aureus(MRSA) and methicillin-resistant coagulase-negative Staphylococcus(MRCNS) was 39.1% and78.0%, respectively. No staphylococcal strains were resistant to vancomycin or linezolid. The prevalence of ESBLs-producing E.coli and K. pneumoniae was 63.0% and 47.4%, respectively. Enterobacteriaceae strains were still highly susceptible to carbapenems.A. baumannii isolates showed high resistance rates(>80%) to most of antibacterial agents tested. P. aeruginosa isolates showed high sensitivity rates to aztreonam, amikacin, gentamicin, ciprofloxacin and levofloxacin, all of which were active against ≥80%of the P. ?aeruginosa isolates. Anaerobic strains were 100% susceptible to piperacillin-tazobactam and imipenem. Candida species were 100% sensitive to 5-fluorouracil, amphotericin B, fluconazole, itraconazole, and voriconazole. Conclusions Staphylococcus and E. coli are the most common pathogens of BSI in orthopedic patients. It is necessary to strengthen hospital infection control in orthopedic wards for reducing the incidence of BSI.
Objective To investigate the clinical characteristics and antimicrobial resistance of blood stream infections(BSIs)in orthopedic patients for appropriate clinical diagnosis and antimicrobial therapy. Methods The clinical data of the orthopedic patients with BSI from January 2012 to December 2017 were retrospectively analyzed in Beijing Jishuitan Hospital. Results A total of 200 cases were enrolled, including 132 males(66.0%) and 68 females(34.0%). Open fracture was the main predisposing factor of BSI in orthopedic patients, including 62 cases(31.0%) of single open fracture and 89 cases(44.5%) of multiple open fractures.Single microorganism infection was identified in 182 cases(91.0%), and multiple microorganisms mixed infection in 18 cases(9.0%).Underlying disease was found in 55 cases(27.5%). A total of 218 non-duplicate isolates were collected, including 108 strains of gram-negative bacteria(49.5%), 91 strains of gram-positive bacteria(41.7%), 10 strains of anaerobic bacteria(4.6%), and 9 strains of fungi(4.1%). The top six bacterial species were coagulasenegative Staphylococcus(41, 18.8%), Escherichia coli(27,12.4%), Staphylococcus aureus(23, 10.6%), Klebsiella pneumoniae(19, 8.7%), Acinetobacter baumannii(14, 6.4%),and Pseudomonas aeruginosa(11, 5.0%). The prevalence of methicillin-resistant S. aureus(MRSA) and methicillin-resistant coagulase-negative Staphylococcus(MRCNS) was 39.1% and78.0%, respectively. No staphylococcal strains were resistant to vancomycin or linezolid. The prevalence of ESBLs-producing E.coli and K. pneumoniae was 63.0% and 47.4%, respectively. Enterobacteriaceae strains were still highly susceptible to carbapenems.A. baumannii isolates showed high resistance rates(>80%) to most of antibacterial agents tested. P. aeruginosa isolates showed high sensitivity rates to aztreonam, amikacin, gentamicin, ciprofloxacin and levofloxacin, all of which were active against ≥80%of the P. ?aeruginosa isolates. Anaerobic strains were 100% susceptible to piperacillin-tazobactam and imipenem. Candida species were 100% sensitive to 5-fluorouracil, amphotericin B, fluconazole, itraconazole, and voriconazole. Conclusions Staphylococcus and E. coli are the most common pathogens of BSI in orthopedic patients. It is necessary to strengthen hospital infection control in orthopedic wards for reducing the incidence of BSI.
引文
[1]叶丽艳,袁培,马艳宁,等.216例混合血流感染患者的病原菌分布及耐药分析[J].中华医院感染学杂志,2017,27(4):750-753.
[2]沈振华,刘兴晖,朱慧,等.血流感染病原菌分布及其体外药物敏感性试验结果分析[J].检验医学,2016,31(10):854-857.
[3]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.
[4]中华人民共和国国家卫生和计划生育委员会.临床微生物实验室血培养操作规范(WS/T 503-2017)[S/OL].[2018-09-01].http://www.nhc.gov.cn/wjw/s9492/wsbz.shtml.
[5]陈瑞娟,芮庆林,郭涛,等.重症监护病房血流感染的临床特点和病原学分析[J].中国感染与化疗杂志,2016,16(6):673-679.
[6]郭健莲,肖斌龙,刘惠娜,等.血培养报阳时间在鉴别血流感染和采血污染中的应用[J].中国感染控制杂志,2015,14(12):803-806.
[7]姜可伟,吕游,郭鹏,等.2008-2011年北京大学人民医院外科血流感染病原菌的分布及耐药性分析[J].中国实用外科杂志,2013,33(6):500-503.
[8]TRETHON A,PRINZ G,VARGA A,et al.Characteristics of nosocomial bloodstream infections at a Hungarian cardiac surgery centre[J].Acta Microbiol Immunol Hung,2012,59(2):271-283.
[9]METSEMAKERS W J,KUEHL R,MORIARTY T F,et al.Infection after fracture fixation:Current surgical and microbiological concepts[J].Injury,2018,49(3):511-522.
[10]申凤彩,解迪,韩钱鹏,等.ICU血流感染病原菌特征及混合血流感染的危险因素分析[J].中华危重病急救医学,2015,27(9):718-723.
[11]查翔远,潘晓龙,胡志军,等.2010-2014年血培养分离菌的分布及耐药性分析[J].中国感染与化疗杂志,2016,16(5):602-607.
[12]杨超,王海英,刘大钺,等.外科感染患者细菌分布及耐药性分析[J].中华医院感染学杂志,2011,21(20):4388-4390.
[13]薛峰,吕媛.Mohnarin2009年度报告:血标本来源的细菌耐药监测[J].中国临床药理学杂志,2011,27(5):352-356.
[14]王艳,张会英,吴俊,等.骨科感染患者革兰阳性球菌的耐药监测研究[J].检验医学与临床,2016,13(1):16-17,20.
[15]胡付品,郭燕,朱德妹,等.2017年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2018,18(3):241-251.
[16]王艳,张会英,吴俊,等.48例厌氧菌血流感染的临床特点及耐药性分析[J].中华实验和临床感染病杂志(电子版),2017,11(6):573-577.
[2]沈振华,刘兴晖,朱慧,等.血流感染病原菌分布及其体外药物敏感性试验结果分析[J].检验医学,2016,31(10):854-857.
[3]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.
[4]中华人民共和国国家卫生和计划生育委员会.临床微生物实验室血培养操作规范(WS/T 503-2017)[S/OL].[2018-09-01].http://www.nhc.gov.cn/wjw/s9492/wsbz.shtml.
[5]陈瑞娟,芮庆林,郭涛,等.重症监护病房血流感染的临床特点和病原学分析[J].中国感染与化疗杂志,2016,16(6):673-679.
[6]郭健莲,肖斌龙,刘惠娜,等.血培养报阳时间在鉴别血流感染和采血污染中的应用[J].中国感染控制杂志,2015,14(12):803-806.
[7]姜可伟,吕游,郭鹏,等.2008-2011年北京大学人民医院外科血流感染病原菌的分布及耐药性分析[J].中国实用外科杂志,2013,33(6):500-503.
[8]TRETHON A,PRINZ G,VARGA A,et al.Characteristics of nosocomial bloodstream infections at a Hungarian cardiac surgery centre[J].Acta Microbiol Immunol Hung,2012,59(2):271-283.
[9]METSEMAKERS W J,KUEHL R,MORIARTY T F,et al.Infection after fracture fixation:Current surgical and microbiological concepts[J].Injury,2018,49(3):511-522.
[10]申凤彩,解迪,韩钱鹏,等.ICU血流感染病原菌特征及混合血流感染的危险因素分析[J].中华危重病急救医学,2015,27(9):718-723.
[11]查翔远,潘晓龙,胡志军,等.2010-2014年血培养分离菌的分布及耐药性分析[J].中国感染与化疗杂志,2016,16(5):602-607.
[12]杨超,王海英,刘大钺,等.外科感染患者细菌分布及耐药性分析[J].中华医院感染学杂志,2011,21(20):4388-4390.
[13]薛峰,吕媛.Mohnarin2009年度报告:血标本来源的细菌耐药监测[J].中国临床药理学杂志,2011,27(5):352-356.
[14]王艳,张会英,吴俊,等.骨科感染患者革兰阳性球菌的耐药监测研究[J].检验医学与临床,2016,13(1):16-17,20.
[15]胡付品,郭燕,朱德妹,等.2017年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2018,18(3):241-251.
[16]王艳,张会英,吴俊,等.48例厌氧菌血流感染的临床特点及耐药性分析[J].中华实验和临床感染病杂志(电子版),2017,11(6):573-577.