文章摘要
吴远帆,刘成成,范 坤,周苏明.2016—2019年老年医学科重症监护室患者血流感染病原菌的分布与耐药性分析[J].南京医科大学学报,2021,(4):586~592
2016—2019年老年医学科重症监护室患者血流感染病原菌的分布与耐药性分析
Distribution and drug resistance of pathogens from patients with bloodstream infection in intensive care unit of geriatric medicine from 2016 to 2019
投稿时间:2020-08-01  
DOI:10.7655/NYDXBNS20210419
中文关键词: 老年  重症  血培养  病原菌  耐药
英文关键词: geriatric  severe  blood culture  bacteria  drug resistance
基金项目:江苏省干部保健科研课题(BJ18015)
作者单位
吴远帆 南京医科大学第一附属医院老年医学科ICU江苏 南京 210029 
刘成成 南京医科大学第一附属医院检验学部江苏 南京 210029 
范 坤 南京医科大学第一附属医院检验学部江苏 南京 210029 
周苏明 南京医科大学第一附属医院老年医学科ICU江苏 南京 210029 
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中文摘要:
      目的:分析某院老年医学科重症监护室患者血流感染病原菌分布及耐药性。方法:收集2016年1月—2019年12月该院老年医学科重症监护室住院患者血培养数据并用WHONET 5.6软件统计分析。将血培养阳性患者按年龄分为老年组(≥60岁)与非老年组(<60岁),比较两组患者血流感染病原菌的构成以及耐药性。结果:96例血培养阳性患者共分离到病原菌100株。其中,革兰阴性菌占63.0%,革兰阳性菌占22.0%,真菌占10.0%,厌氧菌占5.0%。革兰阴性菌检出居前3位的依次是肺炎克雷伯菌(25.0%)、大肠埃希菌(13.0%)、鲍曼不动杆菌(11.0%)。革兰阳性菌检出居前3位的依次是肠球菌(8.0%)、金黄色葡萄球菌(7.0%)和α?溶血性链球菌(7.0%)。肺炎克雷伯菌中碳青霉烯耐药肠杆科细菌(carbapenem?resistant Enterobacteriaceae,CRE)占76%,其中检测到1株对头孢他定/阿维巴坦耐药的肺炎克雷伯菌,未检测到对替加环素或多黏菌素B耐药的菌株;鲍曼不动杆菌中碳青霉烯耐药鲍曼不动杆菌(carbapenem?resistant A. baumannii,CRAB)占81.8%,其中检测到1株对替加环素耐药,未检测到对多黏菌素B耐药的菌株;金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌(methicillin?resistant Staphylococcus aureus,MRSA)占57.2%,未发现耐万古霉素和利奈唑胺的金黄色葡萄球菌。此外,检出1 株耐万古霉素屎肠球菌。两组患者分离的病原菌分布构成相似。与非老年组相比,老年组病原菌耐药率更高。结论:该院老年医学科重症监护室血流感染的病原菌以革兰阴性杆菌为主,且对碳青霉烯类药物耐药率高。
英文摘要:
      Objective:To investigate the clinical distribution and resistance characteristics of pathogens isolated from bloodstream infection patients in a intensive care unit of geriatric medicine(geriatric ICU)in a tertiary teaching hospital. Methods:Blood culture results and clinical data of hospitalized patients in geriatric ICU from 2016 to 2019 were collected and then analyzed using WHONET 5.6 software. Patients with positive blood culture were divided into old group(≥60 years)and non?old group(<60 years)according to age. And the constitute as well as drug resistance of blood culture pathogens were compared between the two groups. Results:A total of 100 strains of pathogen were isolated from 96 patients with positive blood culture. Of the 100 isolates,gram negative bacilli,gram positive cocci,fungi and anaerobes accounted for 63%,22%,10%,and 5%,respectively. The top three gram negative pathogens were K. pneumoniae(25%),E. coli(13%)and A. baumannii(11%). The top three gram positive pathogens were Enterococcus(25%),S. aureus(13%)and viridians Streptococcus(11%). The proportion of carbapenem?resistant Enterobacteriaceae(CRE)in K. pneumoniae,carbapenem?resistant A. baumannii(CRAB)in A. baumannii and methicillin?resistant Staphylococcus aureus(MRSA)in S. aureus were 72.0%,81.3% and 57.2%,respectively. E. coli resistant to carbapenem and S.aureus resistant to vancomycin or linezolid were not found. One strain of E. faecium was identified as resistant to vancomycin. Almost all CRE strains were not resistant to tigecyclin,polymyxin B or ceftazidime?avibactam except one strain of K. pneumoniae that was determined to be resistant to ceftazidime?avibactam. Among CRAB,only one strain showed resistance to tigecyclin,and no resistance to tigecyclin or polymyxin B was detected in others. There was no significant differences in pathogen distribution between old and non?old group. Compared with non?old group,pathogens in old group showed higher drug resistance. Conclution:Gram?negative bacteria with high drug resistance to carbapenem were the dominant pathogens associated with bloodstream infection in old severe patients in geriatric ICU. And bacterial resistance surveillance might be helpful for guiding rational use of antimicrobial agents in clinic.
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