临床荟萃 ›› 2021, Vol. 36 ›› Issue (8): 724-729.doi: 10.3969/j.issn.1004-583X.2021.08.010

• 论著 • 上一篇    下一篇

血流感染病原菌耐药性和血流感染预后分析

彭振丽(), 姜尧, 贾丽娟, 王燕新, 薛唯潇, 史慧婷   

  1. 清华大学附属垂杨柳医院(北京市垂杨柳医院) 重症医学科,北京 100022
  • 收稿日期:2021-07-15 出版日期:2021-08-20 发布日期:2021-08-30
  • 通讯作者: 彭振丽 E-mail:pengzhenli@163.com
  • 基金资助:
    朝阳区科技计划项目——两类重点人群CAP病毒病原基因分析与危重症治疗直通路径研究(CYSF1919)

Analysis of pathogenic bacteria resistance and prognosis of bloodstream infection

Peng Zhenli(), Jiang Yao, Jia Lijuan, Wang Yanxin, Xue Weixiao, Shi Huiting   

  1. Department of Critical Care Medicine, Chui Yang Liu Hospital Affiliated to Tsinghua University, Beijing 100022, China
  • Received:2021-07-15 Online:2021-08-20 Published:2021-08-30
  • Contact: Peng Zhenli E-mail:pengzhenli@163.com

摘要:

目的 研究重症医学科(ICU)内血流感染病原菌耐药性,分析血流感染预后的影响因素,为早期抗菌治疗提供参考。方法 采用回顾性研究方法统计2014年1月至2020年12月清华大学附属垂杨柳医院ICU确诊为血流感染患者的临床资料,对血培养阳性病原菌构成特点及耐药情况进行分析。根据住院期间存活和死亡,分为存活组和非存活组,收集性别、年龄、是否医院感染、基础疾病、血培养阳性报警时间、血流感染发生时间等,将单变量分析中差异有统计学意义的因素纳入Logistic回归分析,进一步分析影响患者预后的因素。结果 病例资料完整的血流感染患者80例,共分离出病原菌84株。血流感染病原菌依次为凝固酶阴性葡萄球菌、金黄色葡萄球菌、大肠埃希菌、不动杆菌、肺炎克雷伯菌。67.86%病原菌为多重耐药菌株。未发现对万古霉素、利奈唑胺、替考拉宁耐药革兰阳性菌株。产ESBLs肺炎克雷伯菌和大肠埃希菌对头孢噻肟、头孢吡肟、氨曲南、环丙沙星、左氧氟沙星、莫西沙星、四环素、氯霉素耐药率高。单因素分析显示,血培养同时生长2种致病菌与血流感染预后有关(P<0.05),多因素Logistic回归分析未发现与血流感染预后相关的危险因素。结论 不同地区和医院,血流感染病原菌分布差异较大,本院ICU血流感染病原菌以革兰阳性菌为主,主要为耐甲氧西林葡萄球菌。重症患者血流感染病情复杂,影响预后因素较多,需要大样本、多中心研究。

关键词: 血流感染, 血培养, 病原菌, 耐药

Abstract:

Objective To study the pathogenic bacteria resistance in patients with bloodstream infections in intensive care unit(ICU), to analyze the prognostic factors for bloodstream infection, and to provide references for early antibacterial treatment. Methods Retrospective research method was used to count the clinical data of patients diagnosed with bloodstream infection in the Department of ICU of Chui Yang Liu Hospital Affiliated to Tsinghua University from January 2014 to December 2020, and the constitute and resistance of blood culture-positive pathogens were analyzed. The patients were divided into survival and non-survival groups according to the survival and death during the hospitalization period. The gender, age, hospital infection, underlying disease, time-to-positivity of blood culture, occurrence time of bloodstream infection, etc. were collected. Factors in which the differences were statistically significant in univariate analysis were included in Logistic regression analysis to further analyze the factors affecting patients' prognosis. Results There were 80 cases of bloodstream infection patients with complete case data, and a total of 84 strains of pathogens were isolated. Pathogens of bloodstream infections were coagulase-negative staphylococci, staphylococcus aureus, escherichia coli, acinetobacter, and klebsiella pneumoniae in turn. Pathogens with the percent of 67.86% are multi-drug resistant strains. No gram-positive strains resistant to vancomycin, linezolid and teicoplanin were found. ESBLs-producing Klebsiella pneumoniae and Escherichia coli had high resistance rates to cefotaxime, cefepime, aztreonam, ciprofloxacin, levofloxacin, moxifloxacin, tetracycline, and chloramphenicol. Univariate analysis showed that two pathogenic bacteria simultaneously growing in the blood culture were related to the prognosis of bloodstream infection(P<0.05), and no risk factor related to the prognosis of bloodstream infection was found in multivariate logistic regression analysis.Conclusion The distribution of bloodstream infection pathogens varies greatly in different regions and hospitals. Main pathogens of bloodstream infections in the Department of ICU in this hospital are dominated by Gram-positive bacteria, and its mainly composed methicillin-resistant Staphylococcus. The condition of severely ill patients with bloodstream infection is complex, there are many factors influencing the prognosis, great samples and multicenter studies are required.

Key words: bloodstream infection, blood culture, pathogen, drug resistance

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