【摘要】 目的 探讨胃肠外科术后中心静脉导管感染情况、病原菌特点及其耐药性,为临床合理用药提供依据。方法 对389例胃肠外科术后留置中心静脉导管患者的临床资料进行整理分析,内容包括导管感染发生情况、感染病原菌分布、耐药性分析。结果 本组患者感染率为16.7%。感染病原菌分布:革兰阳性菌感染率(54.2%)>革兰阴性菌感染率(33.3%)>真菌感染率(12.5%),不同病原菌感染率比较差异有统计学意义(P<0.05);金黄色葡萄球菌、鲍氏不动杆菌和白色假丝酵母菌分别是最主要的革兰阳性菌、革兰阴性菌和真菌,分别占29.2%、15.3%和6.9%。耐药性分析:金黄色葡萄球菌对红霉素、青霉素、阿莫西林/克拉维酸和苯唑西林的耐药率均>80%;对环丙沙星、利福平、阿米卡星和替考拉宁较为敏感,耐药率<30%,未发现对万古霉素耐药的金黄色葡萄球菌。鲍氏不动杆菌对氨苄西林、头孢呋辛、头孢唑林、阿米卡星、氨曲南和庆大霉素耐药率均>90%,对头孢哌酮/舒巴坦相对敏感,耐药率<20%。未检出对伊曲康唑、制霉菌素、两性霉素B和氟康唑耐药的白色假丝酵母菌。结论 胃肠外科术后中心静脉导管相关性感染发生率高,病原菌种类呈现多样化,以革兰阳性菌感染为主,耐药现象严重,应引起临床注意,对发生感染者要有针对性地予以抗生素治疗。更多还原

【Abstract】 Objective To observe the central venous catheter infection status, pathogen characteristics,and its drug resistance, in order to provide basis for clinical rational drug use. Methods Clinical data of 398 cases with central venous catheter in gastrointestinal surgery department were analyzed, including catheter infection occurrence, the distribution of pathogenic bacteria, and drug resistance analysis. Results The infection rate of this group was 16. 7%. Distribution of pathogenic bacteria: Gram-positive bacteria infection rate(54. 2%)>Gram-negative bacteria infection rate(33. 3%)>fungi infection rate(12. 5%),the difference of infection rate among different pathogens had statistic significance(P<0. 05); Staphylococcus aureus, Acinetobacter spp and Candida albicans were the most important Gram-positive bacteria,Gram-negative bacteria and fungi, accounting for 29. 2%, 15. 3% and 6. 9%, respectively. Drug resistance analysis: resistance rates of staphylococcus aureus to erythromycin, penicillin, amoxicillin/clavulanate and oxacillin were >80%; while sensitive to ciprofloxacin, rifampicin, amikacin and teicoplanin, and resistance rates were < 30 % staphylococcus aureus that resistant to vancomycin was not found. Acinetobacter baumannii showed high resistance to ampicillin, cefuroxime, cefazolin, amikacin, aztreonam and gentamicin, and resistance rates were >90%, sensitive to cefoperazone/sulbactam, and resistance rates were < 20%. All fungi did not exhibit resistance to iitraconazole,nystatin, amphotericin B and fluconazole. Conclusion Central venous catheter-related infection has higher occurrence rate in gastrointestinal surgery department, pathogenic species are diverse, mainly infect with Gram-positive bacteria, drug-resistant is serious, which should cause clinical attention, and infected person should be given targeted antibiotic therapy.更多还原