烧伤患者院内感染病原菌分布及耐药性分析
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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。
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 Grampositive bacteria was 69.1%(94/136). The resistance rate of Enterococcus spp. to antibiotics was 38.9%-66.3%. No Grampositive 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.
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 Grampositive bacteria was 69.1%(94/136). The resistance rate of Enterococcus spp. to antibiotics was 38.9%-66.3%. No Grampositive 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.
引文
[1]LACHIEWICZ A M,HAUCK C G,WEBER D J,CAIRNS B A,VAN DUIN D.Bacterial infections after burn injuries:impact of multidrug resistance[J].Clin Infect Dis,2017,65:2130-2136.
[2]姚新宝,李娟,刘利华,马金山.烧伤患者创面感染病原菌分布及耐药性监测[J].新疆医科大学学报,2016,39:1538-1540,1558.
[3]KRISHNAN P,FREW Q,GREEN A,MARTIN R,DZIEWULSKI P.Cause of death and correlation with autopsy findings in burns patients[J].Burns,2013,39:583-588.
[4]张磊,付辉,董肇杨,彭媛,李灿.2007-2016年小儿烧伤住院患者感染病原菌分布及耐药性分析[J].中华灾害救援医学,2017,5:685-689.
[5]杨洋,郭燕,朱德妹,胡付品,汪复,蒋晓飞,等.2017年上海市细菌耐药性监测[J].中国感染与化疗杂志,2019,19:113-127.
[6]尚红,王毓三,申子瑜.全国临床检验操作规程[M].4版.北京:人民卫生出版社,2014:569-570.
[7]SEROUR F,STEIN M,GORENSTEIN A,SOMEKHE.Early burn related gram positive systemic infection in children admitted to a pediatric surgical ward[J].Burns,2006,32:352-356.
[8]蔡海军.烧伤患者感染的病原菌分布及耐药性分析[J].中华医院感染学杂志,2012,22:2426-2448.
[9]徐正鹏,王栗,韩立中,王文奎.烧伤住院患者感染病原菌的分布及耐药性分析[J].上海交通大学学报,2017,37:527-531.
[10]徐风瑞,乔亮,何明武,杨帆,姚忠军.烧伤患者感染耐碳青霉烯类肺炎克雷伯菌耐药趋势与抗菌药物使用分析[J].中华医院感染学杂志,2016,26:1474-1476,1488.
[11]黄亚雨,涂海健,郑磊.耐碳青霉烯类肺炎克雷伯菌的耐药机制及同源性分析[J].山东医药,2018,58:28-31.
[12]吴红,谢卫国,丁汉梅,金文平,李莉.烧伤中心分离菌变迁趋势及院内感染综合防控的研究[J/CD].中华损伤与修复杂志(电子版),2011,6:381-387.
[13]陈佰义,何礼贤,胡必杰,倪语星,邱海波,石岩,等.中国鲍曼不动杆菌感染诊治与防控专家共识[J].中国医药科学,2012,2:3-8.
[14]倪俊,顾海峰,许献荣,陈瑞彩,张杏梅.烧伤病房不同病种患者创面病原菌分布及耐药性对比研究[J].中华医院感染学杂志,2013,23:4832-4834.
[15]倪俊,许献荣,陈瑞彩.难愈性创面感染的病原菌分布及定植感染相关因素[J].中华实验和临床感染病杂志,2018,12:35-39.
[16]MCGUINNESS W A,MALACHOWA N,DELEO F R.Vancomycin resistance in Staphylococcus aureus[J].Yale J Biol Med,2017,90:269-281.
[17]PANESSO D,PLANET P J,DIAZ L,HUGONNET JE,TRAN T T,NARECHANIA A,et al.Methicillinsusceptible,vancomycin-resistant Staphylococcus aureus,Brazil[J].Emerg Infect Dis,2015,21:1844-1848.
[2]姚新宝,李娟,刘利华,马金山.烧伤患者创面感染病原菌分布及耐药性监测[J].新疆医科大学学报,2016,39:1538-1540,1558.
[3]KRISHNAN P,FREW Q,GREEN A,MARTIN R,DZIEWULSKI P.Cause of death and correlation with autopsy findings in burns patients[J].Burns,2013,39:583-588.
[4]张磊,付辉,董肇杨,彭媛,李灿.2007-2016年小儿烧伤住院患者感染病原菌分布及耐药性分析[J].中华灾害救援医学,2017,5:685-689.
[5]杨洋,郭燕,朱德妹,胡付品,汪复,蒋晓飞,等.2017年上海市细菌耐药性监测[J].中国感染与化疗杂志,2019,19:113-127.
[6]尚红,王毓三,申子瑜.全国临床检验操作规程[M].4版.北京:人民卫生出版社,2014:569-570.
[7]SEROUR F,STEIN M,GORENSTEIN A,SOMEKHE.Early burn related gram positive systemic infection in children admitted to a pediatric surgical ward[J].Burns,2006,32:352-356.
[8]蔡海军.烧伤患者感染的病原菌分布及耐药性分析[J].中华医院感染学杂志,2012,22:2426-2448.
[9]徐正鹏,王栗,韩立中,王文奎.烧伤住院患者感染病原菌的分布及耐药性分析[J].上海交通大学学报,2017,37:527-531.
[10]徐风瑞,乔亮,何明武,杨帆,姚忠军.烧伤患者感染耐碳青霉烯类肺炎克雷伯菌耐药趋势与抗菌药物使用分析[J].中华医院感染学杂志,2016,26:1474-1476,1488.
[11]黄亚雨,涂海健,郑磊.耐碳青霉烯类肺炎克雷伯菌的耐药机制及同源性分析[J].山东医药,2018,58:28-31.
[12]吴红,谢卫国,丁汉梅,金文平,李莉.烧伤中心分离菌变迁趋势及院内感染综合防控的研究[J/CD].中华损伤与修复杂志(电子版),2011,6:381-387.
[13]陈佰义,何礼贤,胡必杰,倪语星,邱海波,石岩,等.中国鲍曼不动杆菌感染诊治与防控专家共识[J].中国医药科学,2012,2:3-8.
[14]倪俊,顾海峰,许献荣,陈瑞彩,张杏梅.烧伤病房不同病种患者创面病原菌分布及耐药性对比研究[J].中华医院感染学杂志,2013,23:4832-4834.
[15]倪俊,许献荣,陈瑞彩.难愈性创面感染的病原菌分布及定植感染相关因素[J].中华实验和临床感染病杂志,2018,12:35-39.
[16]MCGUINNESS W A,MALACHOWA N,DELEO F R.Vancomycin resistance in Staphylococcus aureus[J].Yale J Biol Med,2017,90:269-281.
[17]PANESSO D,PLANET P J,DIAZ L,HUGONNET JE,TRAN T T,NARECHANIA A,et al.Methicillinsusceptible,vancomycin-resistant Staphylococcus aureus,Brazil[J].Emerg Infect Dis,2015,21:1844-1848.
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