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目的研究急诊创伤患者血标本分离病原菌分布及其耐药性情况,为临床合理应用抗菌药物提供依据。方法通过细菌分离培养和鉴定技术,对北京市某急救中心急诊创伤患者送检血标本进行监测。结果从39 439份血标本中共分离出病原菌2 801株,阳性率为7.1%;剔除重复菌株后,共计1 604株。血液标本分离病原菌中,革兰阳性球菌构成比为48.8%,其中凝固酶阴性葡萄球菌占59.00%,耐甲氧西林金黄色葡萄球菌占39.8%;革兰阴性杆菌占45.8%,真菌占5.4%。葡萄球菌属对万古霉素、利奈唑胺、替考拉宁等均敏感。革兰阴性杆菌中鲍曼不动杆菌和铜绿假单胞菌对碳青霉烯类耐药率超过30%。采血前皮肤清洁方式、导管留置时间比较差异有统计学意义(P<0.05)。结论急诊创伤患者血液标本中检出革兰阳性和革兰阴性菌群比例接近,革兰阴性杆菌耐药更为严重。采血前皮肤清洁与动静脉置管长短是导致血培养感染的危险因素,应采取综合预防措施。
Objective To study the distribution of pathogens and their drug resistance in blood samples of patients with emergency trauma and to provide basis for clinical rational use of antimicrobial agents. Methods Bacterial isolates, culture and identification techniques were used to monitor blood samples from emergency trauma patients in an emergency center in Beijing. Results A total of 2 801 pathogenic bacteria were isolated from 39 439 blood samples, with a positive rate of 7.1%. After removing the duplicate strains, a total of 1 604 strains were obtained. Among the pathogenic bacteria isolated from blood, the constituent ratio of gram-positive cocci was 48.8%, of which coagulase-negative staphylococcus accounted for 59.00%, methicillin-resistant staphylococcus aureus accounted for 39.8%, gram-negative bacilli accounted for 45.8% and fungi accounted for 5.4% . Staphylococci are sensitive to vancomycin, linezolid, teicoplanin and others. Gram-negative bacilli Acinetobacter baumannii and Pseudomonas aeruginosa carbapenem resistance rate of more than 30%. Pre-blood clean-up methods, catheter indwelling time difference was statistically significant (P <0.05). Conclusion The proportion of Gram-positive and Gram-negative bacteria in the blood samples of patients with acute traumatic injury is close, and Gram-negative bacilli are more resistant. Pre-blood cleanup and arteriovenous catheter skin is the leading cause of blood culture infection risk factors, should take comprehensive preventive measures.