【摘要】 目的探讨尿毒症住院患者感染部位与病原菌分布,为预防和控制患者感染提供依据。方法选取2015年8月-2016年8月于医院血液净化科住院治疗,确诊为慢性肾功能不全尿毒症期并发感染的患者154例为研究对象,统计感染部位构成比,病原菌分布和药敏结果,采用SPSS22.0对数据进行分析。结果下呼吸道感染患者最多,占57.14%;分离出病原菌179株,其中,革兰阴性菌占43.01%,革兰阳性菌占45.81%,真菌占11.18%;革兰阴性菌和革兰阳性菌在不同部位的占比不同,下呼吸道两类细菌占比相似,腹膜和导管以革兰阳性菌为主,分别占62.07%和75.00%,泌尿系革兰阴性菌占70.83%;耐药性分析中,革兰阳性菌耐药率较高,溶血葡萄球菌对青霉素、亚胺培南、美罗培南、哌拉西林耐药率为100%,革兰阳性菌对替考拉宁、万古霉素、美满霉素、利奈唑胺耐药率低于10%;革兰阴性菌对哌拉西林、阿米卡星、美满霉素耐药率低于20%,大肠埃希菌对环丙沙星、左氧氟沙星、庆大霉素、磺胺甲噁唑/甲氧苄啶、四环素耐药率>50%;真菌耐药率均低于15%。结论尿毒症患者感染发生部位广泛,病原菌多为院内常见致病菌,耐药性高,应根据药敏结果合理应用抗菌药物。更多还原

【Abstract】 OBJECTIVE To explore the infection sites of hospitalized patients with uremia and analyze the distribution of pathogens so as to provide guidance for prevention and control of the infection.METHODS A total of 154 patients who were diagnosed with chronic renal insufficiency uremia complicated with infection and were hospitalized for treatment in department of blood purification from Aug 2015 to Aug 2016 were enrolled in the study.The constituent ratios of infection sites,distribution of pathogens,and result of drug susceptibility testing were statistically analyzed;the data were analyzed with the use of SPSS22.0software.RESULTS The patients with lower respiratory tract infection were dominant,accounting for 57.14%.Totally 179 strains of pathogens were isolated,of which 43.01% were gram-negative bacteria,45.81% were gram-positive bacteria,and 11.18% were fungi.The gram-negative bacteria differed from the gram-positive bacteria in the proportions of the infection sites.Among the bacteria causing the lower respiratory tract infection,the proportion of the gram-negative bacteria was approximate to the proportion of the gram-positive bacteria,the gram-positive bacteria causing the peritoneal infection accounted for 62.07%,the gram-positive bacteria causing the catheter-related infection 75.00%;the gramnegative bacteria causing the urinary tract infection accounted for 70.83%.The drug resistance rate of the grampositive bacteria was relatively high,the drug resistance rates of the Staphylococcus haemolyticus to penicillin,imipenem,meropenem,and piperacillin were 100%;the drug resistance rates of the gram-positive bacteria to teicoplanin,vancomycin,minocycline,and linezolid were less than 10%.The drug resistance rates of the gramnegative bacteria to piperacillin,amikacin,and minocycline were less than 20%;the drug resistance rates of the Escherichia coli strains to ciprofloxacin,levofloxacin,gentamicin,sulfamethoxazole-trimethoprim,and tetracycline were more than 50%.The drug resistance rate of the fungi was less than 15%.CONCLUSION The uremia patients have a wide range of sites of infection,the pathogens are prevalent in the hospital and highly drug-resistant,and it is necessary to reasonably use antibiotics based on the result of drug susceptibility testing.更多还原