目的 分析臨滄市人民醫(yī)院2019—2022年腎臟免疫風(fēng)濕科血液透析患者導(dǎo)管相關(guān)性血流感染病原菌分布及耐藥性，為臨床合理預(yù)防及治療導(dǎo)管相關(guān)性血流感染提供參考。方法 搜集2019—2022年臨滄市人民醫(yī)院腎臟免疫風(fēng)濕科送檢的發(fā)生導(dǎo)管相關(guān)性血流感染的血液透析患者的血標(biāo)本，對(duì)其病原菌分布及耐藥性進(jìn)行統(tǒng)計(jì)分析。結(jié)果 共檢出病原菌160株，其中以革蘭陽(yáng)性菌為主，共91株（占56.9%），常見的是表皮葡萄球菌和金黃色葡萄球菌；革蘭陰性菌共69株（占43.1%），常見的是銅綠假單胞菌、大腸埃希菌、嗜麥芽窄食單胞菌和陰溝腸桿菌。表皮葡萄球菌中對(duì)甲氧西林耐藥的菌株檢出率及對(duì)青霉素耐藥率均高于金黃色葡萄球菌，均未檢出對(duì)萬(wàn)古霉素和利奈唑胺耐藥的菌株。大腸埃希菌中產(chǎn)超廣譜β-內(nèi)酰胺酶（ESBL）檢出率為33.3%，低于全國(guó)水平；陰溝腸桿菌對(duì)所監(jiān)測(cè)的抗菌藥物的敏感性較好。銅綠假單胞菌對(duì)絕大多數(shù)抗銅綠假單胞菌藥物的敏感性較好；嗜麥芽窄食單胞菌對(duì)米諾環(huán)素和復(fù)方磺胺甲噁唑的敏感性均大于80%，對(duì)替卡西林/克拉維酸、米諾環(huán)素?zé)o耐藥菌株。結(jié)論 臨滄市人民醫(yī)院血液透析患者導(dǎo)管相關(guān)性血流感染細(xì)菌以革蘭陽(yáng)性菌為主。各病原菌對(duì)臨床常用抗菌藥物的耐藥性各有不同，應(yīng)根據(jù)各病原菌的耐藥特點(diǎn)和抗菌藥物藥物的藥動(dòng)學(xué)/藥效學(xué)選擇合適的抗感染藥物，并及時(shí)送檢微生物培養(yǎng)。

Objective To analyze the detection and drug resistance rate of pathogens associated with catheter-related bloodstream infection in hemodialysis patients in the Department of Renal Immunology and Rheumatology of Lincang People’s Hospital from 2019 to 2022, and to provide reference for clinical rational prevention and treatment of catheter-related bloodstream infection. Methods Blood samples of hemodialysis patients with catheter-associated bloodstream infection were collected from the Department of Renal Immunology and Rheumatology of Lincang People’s Hospital from 2019 to 2022, and the detection and drug resistance rate of pathogenic bacteria were analyzed statistically. Results A total of 160 strains of pathogenic bacteria were detected, of which 91 strains (56.9%) were gram-positive bacteria, and Staphylococcus epidermidis and Staphylococcus aureus were the most common. There were 69 strains of gram-negative bacteria (43.1%), and the most common were Pseudomonas aeruginosa, Escherichia coli, Stenotrophomonas maltophilia and Enterobacter cloacae. The detection rate of methicillin-resistant strains and penicillin resistance rate of Staphylococcus epidermidis were higher than that of Staphylococcus aureus, and no vancomycin and linezolidin-resistant strains were detected. The detection rate of ESBL in Escherichia coli was 33.3%, lower than the national level. The sensitivity of Enterobacter cloacae to the monitored antibiotics was better. Pseudomonas aeruginosa is sensitive to most anti-Pseudomonas aeruginosa drugs. The sensitivity of Stenotrophomonas maltophilia to minocycline and compound sulfamethoxazole was more than 80%, and there was no resistance to ticacillin/clavulanic acid or minocycline. Conclusion Gram-positive bacteria were the main bacteria of catheter-associated bloodstream infection in hemodialysis patients in Lincang People’s Hospital. Each pathogen has different drug resistance to commonly used antibiotics in clinical practice. Appropriate anti-infective drugs should be selected according to the resistance characteristics of each pathogen and PK/PD of antibiotics, and sent to microbial culture in time.

R978.1

臨滄市人民醫(yī)院科技計(jì)劃項(xiàng)目(2018-29);臨滄市科技創(chuàng)新團(tuán)隊(duì)項(xiàng)目(202204AC100002-TD04)