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目的:探讨脓毒症患者病原菌的分布及其耐药情况,为临床合理选用抗菌药物提供指导。方法:回顾性分析277例脓毒症患者的细菌培养和药物敏感性试验结果。结果:277例细菌培养阳性脓毒症患者中,共分离出病原菌349株,其中革兰阴性菌190株,占54.44%,主要致病菌为铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、鲍曼不动杆菌、粘质沙雷菌。革兰阳性菌占32.95%,以凝固酶阴性葡萄球菌、金黄色葡萄球菌居前2位;念珠菌44株,占12.61%。革兰阴性杆菌单产超广谱-内酰胺酶(ESBLs)、单产头孢菌素酶(Amp C)、同产ESBLs+高产Amp C酶检出率分别为19.47%、5.79%、15.26%。革兰阳性分离株除对万古霉素、替考拉宁、喹奴普汀-达福普汀、利福平的耐药率较低外,其余抗生素的耐药率均>50.0%。革兰阴性分离株对亚胺培南、美罗培南、头孢哌酮/舒巴坦的耐药率较低,产酶株较非产酶株具有较高的耐药率。分离革兰阳性与革兰阴性菌株的耐药情况比较严重,特别是铜绿假单胞菌及肠球菌,对多种抗菌药物的耐药率均>50%。念珠菌分离株对5-氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑及伏立康唑的耐药率分别为18.18%,22.72%,52.27%,38.64%和11.36%。结论:脓毒症患者革兰阳性与革兰阴性细菌耐药情况比较严重,念珠菌分离株对氟康唑、伊曲康唑的耐药率较高,建议临床抗感染治疗时,根据实验室药物敏感性试验结果合理选用抗菌药物。
Objective: To investigate the distribution and drug resistance of pathogens in patients with sepsis and provide guidance for rational use of antimicrobial agents in clinical practice. Methods: The bacterial culture and drug susceptibility test results of 277 sepsis patients were retrospectively analyzed. Results: Among 277 patients with positive bacterial sepsis, 349 strains of pathogens were isolated, of which 190 were Gram-negative bacteria, accounting for 54.44%. The main pathogens were Pseudomonas aeruginosa, Escherichia coli, Enterobacter cloacae, Acinetobacter baumannii, Serratia marcescens. Gram-positive bacteria accounted for 32.95%, with coagulase-negative Staphylococcus aureus, Staphylococcus aureus in the top two; Candida 44 strains, accounting for 12.61%. The detection rates of gram-negative bacilli ESBLs, Amp C producing strains and producing AmpC with high ESBLs producing strains were respectively 19.47%, 5.79% and 15.26%. Gram-positive isolates were resistant to vancomycin, teicoplanin, quinuforin-dalfopristin, and rifampicin, with the remaining antibiotic resistance rates> 50.0%. Gram-negative isolates showed low resistance rate to imipenem, meropenem and cefoperazone / sulbactam, and the drug-producing strains had higher resistance rate than non-enzyme-producing strains. Gram-positive and Gram-negative strains isolated more serious resistance, in particular, Pseudomonas aeruginosa and Enterococcus, a variety of antimicrobial resistance rates were> 50%. The resistance rates of Candida isolates to 5-fluorocytosine, amphotericin B, fluconazole, itraconazole and voriconazole were 18.18%, 22.72%, 52.27%, 38.64% and 11.36%, respectively. Conclusion: Gram-positive and Gram-negative bacteria are more resistant to sepsis. Candida isolates have a higher rate of resistance to fluconazole and itraconazole. In clinical anti-infective therapy, Drug susceptibility test results reasonable selection of antimicrobial agents.