摘要
目的:研究导管培养阳性患者的病原菌分布、耐药性以及预后相关危险因素,为临床导管相关性感染提供病原学依据及防治措施。方法:回顾性分析2018—2023年南京医科大学第一附属医院导管培养阳性患者的病原学数据,并收集病原菌检出率排前3位的患者临床资料,分析影响预后的危险因素。结果:导管培养的总体阳性率为14.7%(1240/8407)。去除同一患者分离的相同菌株后,916例患者共分离出病原菌1096株,其中48.7%为革兰阴性菌,主要为肺炎克雷伯菌、鲍曼不动杆菌和大肠埃希菌;革兰阳性菌占39.2%,以金黄色葡萄球菌、表皮葡萄球菌及肠球菌为主。对大多数抗菌药物肺炎克雷伯菌比大肠埃希菌有较高的耐药性,鲍曼不动杆菌对大多数头孢菌素类和碳青霉烯类药物的耐药率均高于85.0%。甲氧西林耐药的金黄色葡萄球菌和表皮葡萄球菌检出率分别为35.6%和92.2%,未检出对万古霉素和利奈唑胺耐药的葡萄球菌和肠球菌。多因素分析显示,男性、年龄≥65岁、有透析病史、合并导管相关性血流感染和气管插管是导管相关性感染患者预后相关的独立危险因素(P<0.05)。结论:导管相关性感染发病率较高,临床需引起关注。持续监测和分析所在地区的病原学特征可为临床经验性抗感染治疗提供理论依据。
Objective:To investigate the distribution,drug resistance of pathogens and prognostic risk factors in patients with positive catheter culture,and to provide pathogenic basis and preventive measures for clinical catheter-related infection.Methods:The etiological data of patients with positive catheter culture in the First Affiliated Hospital of Nanjing Medical University from 2018 to 2023 were retrospectively analyzed,and the clinical data of the patients with the top three pathogens were collected to analyze the risk factors affecting the prognosis.Results:The overall positive rate of catheter culture was 14.7%(1240/8407).After removing the same pathogens isolated from the same patient,a total of 1096 strains of pathogens were isolated from 916 patients,48.7%of which were gram-negative bacteria,mainly Klebsiella pneumoniae,Acinetobacter baumannii,and Escherichia coli.Gram-positive bacteria accounted for 39.2%,mainly Staphylococcus aureus,Staphylococcus epidermidis,and Enterococcus.The resistance rate of Klebsiella pneumoniae to most antibiotics was higher than that of Escherichia coli.The resistance rate of Acinetobacter baumannii to most cephalosporins and carbapenems was higher(>85.0%).The detection rates of methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis were 35.6%and 92.2%,respectively.No vancomycin and linezolid resistant Staphylococcus and Enterococcus were detected.Multivariate analysis showed that male,≥65 years old,history of dialysis,combined catheter-associated bloodstream infection and tracheal intubation were independent risk factors for prognosis in patients with catheter-associated infection(P<0.05).Conclusion:The incidence of catheter-associated infection is high,which needs clinical attention.Continuous monitoring and analysis of etiological characteristics in the local area can provide theoretical basis for clinical empirical anti-infection treatment.
作者
钱莉
金菲
王珏
夏文颖
倪芳
张晓慧
QIAN Li;JIN Fei;WANG Jue;XIA Wenying;NI Fang;ZHANG Xiaohui(Department of Laboratory Medicine,the Fourth Affiliated Hospital of Nanjing Medical University,Nanjing 210031;Department of Laboratory Medicine,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029;Branch of National Clinical Research Center for Laboratory Medicine,Nanjing 210029,China)
出处
《南京医科大学学报(自然科学版)》
北大核心
2025年第8期1194-1201,共8页
Journal of Nanjing Medical University(Natural Sciences)
基金
“十四五”省医学重点学科(ZDXK202239)。
关键词
导管相关性感染
病原菌
耐药性
危险因素
catheter related infection
pathogen
drug resistance
risk factor
