摘要
目的了解呼吸重症监护病房(RICU)肺移植术后患者早期(3个月以内)感染病原菌分布特点及耐药性,为肺移植术后早期感染经验性抗菌药物治疗提供依据。方法收集2017年9月—2018年9月某医院RICU肺移植术后时间<3个月的患者临床资料及病原学数据,对感染病原菌及其耐药性进行统计分析。结果共纳入134例患者,分离感染病原菌349株,革兰阴性菌占91.12%,其中≥2种菌混合感染病例数占91.04%。前三位病原菌依次为鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌,分别占29.51%、16.05%、15.47%。标本主要来自痰(81.09%)和支气管肺泡灌洗液(12.89%)。鲍曼不动杆菌对多粘菌素B耐药率为2.91%,对其余药敏测试药物耐药率为56.31%~100.00%。肺炎克雷伯菌对多粘菌素B耐药率为3.57%,对亚胺培南耐药率达69.64%。铜绿假单胞菌对妥布霉素、阿米卡星、庆大霉素、哌拉西林/他唑巴坦、环丙沙星、左氧氟沙星较敏感,耐药率为1.85%~14.81%,未发现对多粘菌素B耐药的菌株。嗜麦芽窄食单胞菌对左氧氟沙星、复方磺胺甲口恶唑、头孢他啶耐药率较低(8.70%~28.26%)。耐甲氧西林金黄色葡萄球菌(MRSA)检出率为95.24%,未检出耐万古霉素、利奈唑胺的金黄色葡萄球菌。结论RICU肺移植术后患者早期感染病原菌以革兰阴性菌为主,混合感染占比高。不同菌种耐药率存在差异,耐碳青霉烯类鲍曼不动杆菌、肺炎克雷伯检出率较高,需引起临床重视。
Objective To investigate the distribution and antimicrobial resistance of pathogens causing early infection in patients after lung transplantation(within 3 months)in a respiratory intensive care unit(RICU),so as to provide evidence for empirical antimicrobial treatment of early infection after lung transplantation.Methods Clinical and pathogenic data of patients with lung transplantation time<3 months in RICU of a hospital from September 2017 to September 2018 were collected,pathogens and antimicrobial resistance were statistically analyzed.Results A total of 134 patients were included in study,349 strains of pathogens were isolated,Gram-negative bacteria accounted for 91.12%,91.04%of which were mixed infection cases with more than 2 species of strains.The top three pathogens were Acinetobacter baumannii,Klebsiella pneumoniae,and Pseudomonas aeruginosa,accounting for 29.51%,16.05%,and 15.47%respectively.Specimens were mainly from sputum(81.09%)and bronchoalveolar lavage fluid(12.89%).Resistance rate of Acinetobacter baumannii to polymyxin B was 2.91%,and resistance rates to other antimicrobial agents were 56.31%-100.00%.Resistance rates of Klebsiella pneumoniae to polymyxin B and imipenem were 3.57%and 69.64%respectively.Pseudomonas aeruginosa was sensitive to tobramycin,amikacin,gentamicin,piperacillin/tazobactam,ciprofloxacin,and levofloxacin,resistance rates were 1.85%-14.81%,polymyxin B-resistant strains were not found.Resistance rates of Stenotrophomonas maltophilia to levofloxacin,compound sulfamethoxazole and ceftazidime were all low(8.70%-28.26%).Isolation rate of methicillin-resistant Staphylococcus aureus(MRSA)was 95.24%,vancomycin-and linezolid-resistant Staphylococcus aureus strain was not found.Conclusion Gram-negative bacteria are the main pathogens causing early infection in patients after lung transplantation in RICU,the proportion of mixed infection is high.Antimicrobial resistance rates of different strains are varied,isolation rates of carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Klebsiella pneumoniae are higher,which should be paid more attention in clinic.
作者
张秀红
缪丽燕
陈静瑜
杨航
董亮
耿先龙
朱建荣
吴波
ZHANG Xiu-hong;MIAO Li-yan;CHEN Jing-yu;YANG Hang;DONG Liang;GENG Xian-long;ZHU Jian-rong;WU Bo(Department of Pharmacology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China;Department of Pharmacology, The First Affiliated Hospital of Medical College of Soochow University, Suzhou 215006, China;Department of Lung Transplantation, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China;Department of Critical Care Medicine, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China;Department of Laboratory Medicine, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China)
出处
《中国感染控制杂志》
CAS
CSCD
北大核心
2020年第9期785-790,共6页
Chinese Journal of Infection Control
基金
国家自然科学基金(81400054)
江苏省药学会奥赛康医院药学基金(A201729)
无锡市科技发展指导性计划(CSZ0N1604)
江苏省药学会天晴药学基金(Q2019087)。
关键词
肺移植
早期感染
病原菌
分布
耐药性
lung transplantation
early infection
pathogen
distribution
drug resistance
