Analysis of pathogenic bacteria resistance and prognosis of bloodstream infection

doi:10.3969/j.issn.1004-583X.2021.08.010

Abstract

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

CLC Number:

R519.5

Peng Zhenli, Jiang Yao, Jia Lijuan, Wang Yanxin, Xue Weixiao, Shi Huiting. Analysis of pathogenic bacteria resistance and prognosis of bloodstream infection[J]. Clinical Focus, 2021, 36(8): 724-729.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2021.08.010

https://huicui.hebmu.edu.cn/EN/Y2021/V36/I8/724

Figures/Tables 5

References 26

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抗菌药物	MRSA(n=9)		MSSA(n=1)		MRCNS(n=36)		MSCNS(n=4)
抗菌药物	耐药率	敏感率	耐药率	敏感率	耐药率	敏感率	耐药率	敏感率
万古霉素	0	100	0	100	0	100	0	100
替考拉宁	0	100	0	100	0	100	0	100
利奈唑胺	0	100	0	100	0	100	0	100
利福平	44.44	55.56	0	100	11.11	88.89	0	100
环丙沙星	22.22	77.78	0	100	80.56	19.44	25.00	75.00
庆大霉素	12.50	7.78	50.00	50.00	20.00	80.00	75.00	25.00
甲氧苄啶-磺胺甲噁唑	0	100	0	100	33.33	66.667	75.00	25.00
红霉素	11.11	88.89	100	0	100	0	75.00	25.00
克林霉素	66.67	33.33	0	100	30.56	69.44	25.00	75.00
四环素	77.78	22.22	0	100	83.33	91.67	25.00	75.00
青霉素G	100	0	100	0	100	0	100	0
苯唑西林	100	0	0	100	100	0	75.00	25.00

抗菌药物	MRSA(n=9)		MSSA(n=1)		MRCNS(n=36)		MSCNS(n=4)
抗菌药物	耐药率	敏感率	耐药率	敏感率	耐药率	敏感率	耐药率	敏感率
万古霉素	0	100	0	100	0	100	0	100
替考拉宁	0	100	0	100	0	100	0	100
利奈唑胺	0	100	0	100	0	100	0	100
利福平	44.44	55.56	0	100	11.11	88.89	0	100
环丙沙星	22.22	77.78	0	100	80.56	19.44	25.00	75.00
庆大霉素	12.50	7.78	50.00	50.00	20.00	80.00	75.00	25.00
甲氧苄啶-磺胺甲噁唑	0	100	0	100	33.33	66.667	75.00	25.00
红霉素	11.11	88.89	100	0	100	0	75.00	25.00
克林霉素	66.67	33.33	0	100	30.56	69.44	25.00	75.00
四环素	77.78	22.22	0	100	83.33	91.67	25.00	75.00
青霉素G	100	0	100	0	100	0	100	0
苯唑西林	100	0	0	100	100	0	75.00	25.00

抗菌药物	大肠埃希菌				肺炎克雷伯菌				阴沟肠杆菌(n=2)
	ESBLS(+)(n=5)		ESBLS(-)(n=4)		ESBLS(+)(n=5)		ESBLS(-)(n=1)		耐药率	敏感率
	耐药率	敏感率	耐药率	敏感率	耐药率	敏感率	耐药率	敏感率	耐药率	敏感率
阿米卡星	0	100	0	100	20.00	80.00	0	100	0	100
庆大霉素	20.00	80.00	50.00	50.00	60.00	40.00	0	100	0	100
阿莫西林-克拉维酸	40.00	60.00	50.00	50.00	100	0	0	100	100	0
氨苄西林-舒巴坦	20.00	80.00	50.00	50.00	100	0	0	100	100	0
哌拉西林	100	0	25.00	75.00	100	0	0	100	100	0
哌拉西林-他唑巴坦	0	100	0	100	20.00	80.00	0	100	100	0
头孢唑林	100	0	50.00	50.00	100	0	0	100	100	0
头孢他啶	20.00	80.00	0	100	100	0	0	100	0	100
头孢噻肟	100	0	0	100	100	0	0	100	0	100
头孢吡肟	100	0	0	100	100	0	0	100	0	100
氨曲南	100	0	0	100	100	0	0	100	0	100
亚胺培南	0	100	0	100	40.00	60.00	0	100	0	100
美罗培南	0	100	0	100	40	60	0	100	0	100
环丙沙星	80.00	20.00	0	100	80.00	20.00	0	100	0	100
左氧氟沙星	60.00	40.00	0	100	60.00	40.00	0	100	0	100
莫西沙星	80.00	20.00	25.00	75.00	80.00	20.00	25.00	75.00	0	100
甲氧苄啶-磺胺甲噁唑	60.00	40.00	50.00	50.00	60.00	40.00	50.00	50.00	0	100
四环素	80.00	20.00	75.00	25.00	100	0	75.00	25.00	0	100
多黏菌素B	0	100	0	100	0	100	0	100	0	100
氯霉素	60.00	40.00	0	100	60.00	40.00	0	100	0	100

抗菌药物	大肠埃希菌				肺炎克雷伯菌				阴沟肠杆菌(n=2)
	ESBLS(+)(n=5)		ESBLS(-)(n=4)		ESBLS(+)(n=5)		ESBLS(-)(n=1)		耐药率	敏感率
	耐药率	敏感率	耐药率	敏感率	耐药率	敏感率	耐药率	敏感率	耐药率	敏感率
阿米卡星	0	100	0	100	20.00	80.00	0	100	0	100
庆大霉素	20.00	80.00	50.00	50.00	60.00	40.00	0	100	0	100
阿莫西林-克拉维酸	40.00	60.00	50.00	50.00	100	0	0	100	100	0
氨苄西林-舒巴坦	20.00	80.00	50.00	50.00	100	0	0	100	100	0
哌拉西林	100	0	25.00	75.00	100	0	0	100	100	0
哌拉西林-他唑巴坦	0	100	0	100	20.00	80.00	0	100	100	0
头孢唑林	100	0	50.00	50.00	100	0	0	100	100	0
头孢他啶	20.00	80.00	0	100	100	0	0	100	0	100
头孢噻肟	100	0	0	100	100	0	0	100	0	100
头孢吡肟	100	0	0	100	100	0	0	100	0	100
氨曲南	100	0	0	100	100	0	0	100	0	100
亚胺培南	0	100	0	100	40.00	60.00	0	100	0	100
美罗培南	0	100	0	100	40	60	0	100	0	100
环丙沙星	80.00	20.00	0	100	80.00	20.00	0	100	0	100
左氧氟沙星	60.00	40.00	0	100	60.00	40.00	0	100	0	100
莫西沙星	80.00	20.00	25.00	75.00	80.00	20.00	25.00	75.00	0	100
甲氧苄啶-磺胺甲噁唑	60.00	40.00	50.00	50.00	60.00	40.00	50.00	50.00	0	100
四环素	80.00	20.00	75.00	25.00	100	0	75.00	25.00	0	100
多黏菌素B	0	100	0	100	0	100	0	100	0	100
氯霉素	60.00	40.00	0	100	60.00	40.00	0	100	0	100

抗菌药物	不动杆菌属(n=6)		铜绿假单胞菌(n=3)
抗菌药物	耐药率	敏感率	耐药率	敏感率
阿米卡星	33.33	66.67	0	100
庆大霉素	33.33	66.67	0	100
哌拉西林	33.33	66.67	0	100
哌拉西林-他唑巴坦	33.33	66.67	0	100
氨苄西林-舒巴坦	33.33	66.67	100	0
头孢噻肟	33.33	66.67	100	0
头孢他啶	50.00	50.00	0	100
头孢吡肟	33.33	66.67	33.33	66.67
氨曲南	100	0	33.33	66.67
亚胺培南	33.33	66.67	0	100
美罗培南	33.33	66.67	0	100
环丙沙星	50.00	50.00	0	100
左氧氟沙星	50.00	50.00	33.33	66.67
甲氧苄啶-磺胺甲噁唑	0	100	100	0
多黏菌素B	0	100	0	100