论文部分内容阅读
目的 分析心血管外科术后血流感染的病原学特征,为该类疾病的预防和治疗提供参考.方法 回顾性分析2015年1月至2016年12月四川大学华西医院行心血管外科手术后发生血流感染61例患者的临床资料和病原学资料,其中男36例、女25例,平均年龄(48.2±17.1)岁,65.6％(40/61)的患者基础疾病是风湿性心脏病.结果 从61例患者血培养标本共分离到病原菌65株,革兰阳性菌、革兰阴性菌和真菌分别占56.9％(37/65)、35.4％ (23/65)和7.7％ (5/65),菌株以链球菌属最多(19/65,29.2％),其次是表皮葡萄球菌(8/65,12.3％)、金黄色葡萄球菌(6/65,9.2％)、鲍曼/醋酸钙不动杆菌复合体(5/65,7.7％)和大肠埃希菌(5/65,7.7％).链球菌属对红霉素和克林霉素的耐药率分别为73.4％(14/19)和63.2％(12/19),对头孢吡肟、万古霉素和利奈唑胺均敏感,葡萄球菌属对苯唑西林耐药率为71.4％ (10/14),鲍曼/醋酸钙不动杆菌复合体均为多重耐药株(5/5,100.0％),对亚胺培南耐药率为80.0％(4/5);大肠埃希菌中产超广谱内酰胺酶菌株占80.0％ (4/5).结论 心血管外科术后血流感染的常见病原菌是链球菌属.葡萄球菌属和革兰阴性杆菌耐药性较高.“,”Objective To analyze the characteristics of pathogens causing bloodstream infection (BSI) after cardiovascular surgery,and provide instructions for prevention and treatment of such kind of disease.Methods A retrospective investigation of clinical and pathogenic data of the patients suffering from BSI after cardiovascular surgery in West China Hospital of Sichuan University from January 2015 to December 2016 was performed.There were 61 patients with 36 males and 25 females at average age of 48.2± 17.1 years.A percentage of 65.6％ (40/61) of the underlying diseases was rheumatic heart disease.Results Sixty-five strains were isolated from the blood culture specimens of the 61 patients.Gram-positive bacteria,gram-negative bacteria and fungi isolates accounted for 56.9％ (37/65),35.4％ (23/65),and 7.7％ (5/65),respectively.Among these isolates,Streptococcus spp.was predominant (19/65,29.2％),followed by Staphylococcus epidermidis (8/65,12.3％),Staphylococcus aureus (6/65,9.2％),Acinetobacter calcoaceticus-A.baumannii (5/65,7.7％) and Escherichia coli (5/65,7.7％).The resistance rate of Streptococcus spp.to erythromycin and clindamycin was 73.4％ (14/19) and 63.2％ (12/19),while its resistance to cefepime,vancomycin or linezolid was not observed.Staphylococcus spp.showed the resistance rate of 71.4％ (10/14) to oxacillin.All ofA.calcoaceticus-A.baumannii isolates were multidrug resistant (5/5,100.0％),and 80.0％ (4/5) of them were resistant to imipenem.The isolates producing extended spectrum beta-lactamase accounted for 80.0％ (4/5) of E.coli.Conclusion Streptococcus spp.was the common pathogen causing BSI after cardiovascular surgery.Staphylococcus spp.and gram-negative bacilli show high resistance.