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  • 刘云,黄晓春,马炜,李亚周,朱俊,张艳君,万玉香,秦琴.烧伤患者院内感染病原菌分布及耐药性分析[J].第二军医大学学报,2019,40(7):710-715    [点击复制]
  • LIU Yun,HUANG Xiao-chun,MA Wei,LI Ya-zhou,ZHU Jun,ZHANG Yan-jun,WAN Yu-xiang,QIN Qin.Distribution and drug resistance of pathogens causing nosocomial infection in burn patients[J].Acad J Sec Mil Med Univ,2019,40(7):710-715   [点击复制]
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烧伤患者院内感染病原菌分布及耐药性分析
刘云1,黄晓春1,马炜1,李亚周1,朱俊1,张艳君2,万玉香1*,秦琴1*
0
(1. 海军军医大学(第二军医大学)长海医院实验诊断科, 上海 200433;
2. 海军军医大学(第二军医大学)长海医院感染控制科, 上海 200433
*通信作者)
摘要:
目的 分析烧伤患者院内感染病原菌的分布及耐药性,为烧伤患者院内病原菌感染的治疗提供依据。方法 收集2015年1月至2017年12月海军军医大学(第二军医大学)长海医院534例烧伤患者的各类临床标本,分离培养病原菌。使用VITEK 2 Compact全自动微生物分析仪或Microflex基质辅助激光解析飞行时间质谱仪进行细菌鉴定,使用VITEK 2 Compact全自动微生物分析仪进行细菌药物敏感性试验。结果 共分离出1 219株病原菌。其中革兰阴性菌877株(71.9%),位列前4位的菌株分别为肺炎克雷伯菌(203株,16.7%)、铜绿假单胞菌(183株,15.0%)、鲍曼不动杆菌(176株,14.4%)和大肠埃希菌(101株,8.3%);革兰阳性菌342株(28.1%),位列前3位的菌株分别为金黄色葡萄球菌(136株,11.2%)、屎肠球菌(72株,5.9%)和粪肠球菌(60株,4.9%)。病原菌主要来源于创面分泌物(577株,47.3%)、痰/支气管肺泡灌洗液(341株,28.0%)和尿液(147株,12.1%),93.5%(319/341)的痰/支气管肺泡灌洗液病原菌为革兰阴性菌。534例患者中有311例(58.2%)患者分离出2株及以上细菌。革兰阴性菌中肺炎克雷伯菌对常见抗菌药物的耐药率普遍偏高,呈现多重耐药趋势;铜绿假单胞菌耐药情况不容忽视,对碳青霉烯类抗菌药物的耐药率最高为35.5%;鲍曼不动杆菌对碳青霉烯类药物的耐药率最高达93.2%,对其他大部分抗菌药物耐药率>80.0%。革兰阳性菌中耐甲氧西林金黄色葡萄球菌检出率为69.1%(94/136),肠球菌属对常见抗菌药物的耐药率为38.9%~66.3%,但尚未发现对万古霉素、替加环素和利奈唑胺耐药的革兰阳性菌。结论 烧伤患者院内感染病原菌分布较为复杂,超过一半的患者呈多重细菌感染。最常见的致病菌为肺炎克雷伯菌,呈现多重耐药趋势。革兰阳性菌对万古霉素、替加环素和利奈唑胺敏感。
关键词:  烧伤  院内感染  抗菌药  细菌抗药性
DOI:10.16781/j.0258-879x.2019.07.0710
投稿时间:2019-02-18修订日期:2019-06-27
基金项目:国家自然科学基金青年科学基金(31500721),上海青年临床医技人才(临床检验专业)培养资助计划(沪医卫基[2016]04号),上海市科学技术委员会项目(17JC1400900).
Distribution and drug resistance of pathogens causing nosocomial infection in burn patients
LIU Yun1,HUANG Xiao-chun1,MA Wei1,LI Ya-zhou1,ZHU Jun1,ZHANG Yan-jun2,WAN Yu-xiang1*,QIN Qin1*
(Department of Laboratory Medicine, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China;
2. Department of Infection Control, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding authors)
Abstract:
Objective To investigate the pathogen distribution and drug susceptibility profile of isolates from nosocomial infections in burn patients, so as to provide the reference for clinical diagnosis and treatment. Methods A retrospective analysis was carried out for the pathogens isolated from 534 patients in Changhai Hospital of Naval Medical University (Second Military Medical University) during the period from Jan. 2015 to Dec. 2017. The bacteria were identified by VITEK 2 Compact automatic microbiological analyzer or Microflex matrix-assisted laser time-of-flight mass spectrometer. The drug sensitivity was tested by VITEK 2 Compact automatic microbiological analyzer. Results A total of 1 219 strains were isolated, including 877 strains (71.9%) of Gram-negative specimens and 342 strains (28.1%) of Gram-positive pathogens. The top four Gram-negative bacteria were Klebsiella pneumoniae (203 strains, 16.7%), Pseudomonas aeruginosa (183 strains, 15.0%), Acinetobacter baumannii (176 strains, 14.4%) and Escherichia coli (101 strains, 8.3%). The top three Gram-positive bacteria were Staphylococcus aureus (136 strains, 11.2%), Enterococcus faecium (72 strains, 5.9%) and Enterococcus faecalis (60 strains, 4.9%). The pathogens were mainly isolated from wound secretions (577 strains, 47.3%), sputum/bronchoalveolar lavage fluid (341 strains, 28.0%) and urine (147 strains, 12.1%). And 93.5% (319/341) of respiratory pathogens were Gram-negative. Two or more pathogens were isolated from 58.2% (311/534) of the patients. On the top list of Gram-negative pathogens, Klebsiella pneumoniae was observed with a tendency of multi-drug resistance and was resistant to several antibiotics. The drug resistance of Pseudomonas aeruginosa could not be ignored, with a 35.5% resistance rate for carbapenems. The resistance rate of Acinetobacter baumannii to carbapenems could reach as high as 93.2%, with resistance rate >80.0% to most other antimicrobial drugs. The prevalence of methicillin-resistant Staphylococcus aureus in Gram-positive bacteria was 69.1% (94/136). The resistance rate of Enterococcus spp. to antibiotics was 38.9%-66.3%. No Gram-positive pathogens were observed resistant to vancomycin, tigecycline or linezolid. Conclusion The pathogenic isolates causing nosocomial infection in burn patients are multi-bacterium, Klebsiella pneumoniae shows a tendency of multidrug resistance, and Gram-positive pathogens are sensitive to vancomycin, tigecycline and linezolid.
Key words:  burns  nosocomial infection  anti-bacterial agents  bacterial drug resistance