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目的分析内科系统院内感染血培养阳性病例病原学及耐药情况。方法在符合院内感染诊断标准患者寒战或高热时采血,采血后立即按BACTEC操作规程进行培养,培养阳性报警后,进行细菌和真菌鉴定,血培养结果为阳性者进行抗菌药物敏感试验。结果本组资料显示败血症遍及内科系统各个科室,以消化科、血液科、神经内科、呼吸科居多,患者多患有基础疾病,基础疾病以恶性肿瘤、感染性疾病及血液系统疾病居多,从病原体来看,革兰氏阴性菌占66.67%,革兰氏阳性菌占26.17%,真菌为4.17%。排在前几位的细菌分别为大肠埃希氏菌、肺炎克雷伯杆菌、表皮葡萄球菌及金葡菌,分离出的主要致病菌耐药情况显示,革兰氏阴性菌中的大肠埃希氏菌及肺炎克雷伯杆菌,对临床常用抗生素头孢菌素、喹诺酮类、氨基糖甙类及β-内酰胺加酶抑制剂有较高的耐药率,但对碳青酶烯类仍保持较高的敏感性。表皮葡萄球菌及金黄色葡萄球菌除万古霉素、替考拉宁和碳青酶烯类耐药率较低外,其他临床常用抗生素均显示较高比例耐药。本组患者死亡及病情恶化自动出院者占37.5%,治愈好转率仅为62.5%。结论院内感染败血症致病菌多系临床常见耐药菌株,以革兰氏阴性菌居多,临床治愈率低,应加强监测以指导用药。
Objective To analyze the etiology and drug resistance of nosocomial infection blood culture positive cases in medical system. Methods Blood samples were collected during the cholera or hyperthermia in patients with nosocomial infection criteria. Blood was collected and immediately followed by BACTEC protocol. After the positive alarm was raised, the bacteria and fungi were identified and the blood culture results were positive for antimicrobial susceptibility testing. Results This group of data shows that sepsis throughout the medical system in all departments, with gastroenterology, hematology, neurology, respiratory mostly, patients with more underlying diseases, basic diseases with malignant tumors, infectious diseases and hematological diseases are mostly from pathogens Gram-negative bacteria accounted for 66.67%, Gram-positive bacteria accounted for 26.17%, fungi 4.17%. Top row of bacteria were Escherichia coli, Klebsiella pneumoniae, Staphylococcus epidermidis and Staphylococcus aureus, isolated from the main pathogenic bacteria showed resistance, Gram-negative bacteria in the large intestine Corynebacterium pneumoniae and Klebsiella pneumoniae, the commonly used antibiotics cephalosporins, quinolones, aminoglycosides and β-lactamase inhibitors have a higher rate of resistance, but the resistance to carbapenems are still Maintain high sensitivity. Staphylococcus epidermidis and Staphylococcus aureus in addition to vancomycin, teicoplanin and carbapenem resistance rate is low, the other clinically used antibiotics have shown a higher proportion of resistance. This group of patients died and exacerbation of spontaneous discharge accounted for 37.5%, cure improvement rate was only 62.5%. Conclusion Infection with sepsis in hospital is mostly multi-line clinical drug-resistant strains, mostly gram-negative bacteria, clinical cure rate is low, should be strengthened to guide the medication monitoring.