摘要
目的了解近年来血流感染(BSI)病原菌变迁及其对常用抗菌药物的敏感状况。方法根据美国疾病控制中心(CDC)1996年医院感染标准诊断BSI,琼脂扩散法测定病原菌对抗菌药物的敏感性,并对BSI患者的临床特点、病原菌分布及耐药状况进行统计分析。结果1998年1月1日至2003年3月31日上海市华山医院276例确诊BSI者中属社区获得性BSI71例(25.7%),医院获得性BSI205例(74.3%)。276例患者共获病原菌287株。革兰阳性菌、革兰阴性菌、真菌、复数菌感染分别占38%、44.2%、13.8%、4.0%。医院获得性BSI的病原菌以凝固酶阴性葡萄球菌(CoNS)、大肠埃希菌、念珠菌属最为常见。社区获得性BSI的病原菌以草绿色链球菌最常见,其次为大肠埃希菌等。药敏结果显示,48株金葡菌中甲氧西林耐药金葡菌(MRSA)占56%,100株CoNS中甲氧西林耐药CoNS(MRCoNS)占88%。革兰阴性杆菌如肠杆菌科细菌对第3代头孢菌素的耐药率较20世纪80年代、90年代初明显增高。碳青霉烯类对肠杆菌科细菌抗菌活性最强。引起葡萄球菌BSI最常见的诱发因素为静脉留置导管,手术和肾上腺皮质激素的使用。结论CoNS,肺炎克雷伯菌,真菌BSI较上个世纪七、八十年代明显上升,肠杆菌属、不动杆菌属及真菌在医院获得性BSI中明显高于社区获得性BSI,引起BSI病原菌对抗感染药物耐药性较其他部位分离病原菌高。
Objectives To identify the spectrum of pathogens causing bloodstream infection and their resistance profiles. Methods We examined records with positive blood culture from Jan. 1998 to Mar. 2003 in a teaching hospital in Shanghai. The contaminants were excluded according to the CDC definition of bloodstream infection. Bacteria were collected from April 1, 2602 to March 31, 2003 and MIC to the most commonly used antimicrobial agents was performed. Results 276 episodes occurred during the study period. Of all the BSI episodes, about 74.3% BSI were hospital acquired and 37.3 % were community-acquired. Gram-positive organisms accounted for 38 % of isolates, while gram-negatlve for 44.2% and fungus for 13.8%. The commonest pathogens causing bloodstream in fcction in hospital-acquired BSI were coagulase-negative staphylococcus （16.9 %） and Escherichia coil （16.6 % ）, followed by Candida species （ 14. 1 % ）, Staphylococcus aureus （ 13. 7 % ） and Klebsiella pneumoniae （13. 2%）. Streptococcus spp. , Escherichia coli, coagulase-negative staphylococcus and Staphylococcus aureus are the leading pathogens causing community-acquired bloodstream infection, which accounted for 16. 9%, 1,5. 5%, 15. 5%, 11. 3% respectively. Susceptibility tests in vitro shows that methicillin resistance in S. aureus was 56%, while in coagulase-negative staphylococcus was 88%. Among the prevalent Gram-negative BSI isolates, resistance rates for most of the antimicrobial agents were high. However, it is encouraging to note that the carbapenems retained potency against almost all the Enterobaeteriaceae, including those resistant to the third generation cephalospotins and extended broad-spectrum penicillins. The crude mortality rate of BSI was 24.4%. Conclusion The rate of Coagulase-negative staphylococcus, Klebsiella pneumoniae and fungus in BSI have increased in the past years. Enter.obacteriaceae, acinetobacter spp and fungus are more common in hospital acquired BSI than community-acquired BSI.
出处
《中华传染病杂志》
CAS
CSCD
北大核心
2006年第1期29-34,共6页
Chinese Journal of Infectious Diseases
关键词
败血病
交叉感染
抗药性
微生物
Septieemia
Cross infection
Drug resistance, microbial
