154例深静脉置管相关的院内感染分析(1)
[摘要] 目的 分析临床深静脉导管(DVC)培养的病原学特征和耐药性。方法 回顾性分析瑞金医院2010年全年送检的深静脉导管的病原学及其耐药性。结果 991份送检导管病原学阳性154例(15.54%)，检出病原菌176株，其中G+菌、G-菌和真菌各占41.47%、36.36%和22.17%；五种常见病原菌分别是表皮葡萄球菌(20.45%)、鲍曼不动杆菌(15.34%)、金黄色葡萄球菌(11.93%)、白色假丝酵母菌(11.36%)和铜绿假单胞菌(6.25%)。金黄色葡萄球菌中MRSA占94.12%，凝固酶阴性葡萄球菌中MRScn占69.44%；鲍曼不动杆菌、铜绿假单胞菌和肺炎克雷伯菌普遍存在多重耐药现象，鲍曼不动杆菌(26.92%)和铜绿假单胞菌(9.09%)甚至出现全耐药。结论 深静脉导管感染为院内感染，检出的病原菌多为耐药菌，无菌置管、加强导管的护理和加强病原学监测是控制DVC感染的关键。
[关键词] 医院感染；深静脉导管；病原学；耐药性
[中图分类号] R472.9 [文献标识码] B [文章编号] 1673-9701(2011)23-113-02
Descriptive Analysis on the Cases of 154 Deep Venous Cathgeter Tip Related Nosocomial Infection
ZHENG Ailan1 CHEN Junfeng2 HAN Lizhong3
1. Laboratory Department，Hui’an County Hospital of Quanzhou，Hui’an 362100，China； 2.B Type Ultrasonography Room，Hui’an County Hospital of Quanzhou，Hui’an 362100，China；3.Department of Microbiology，Ruijin Hospital Affiliated to Medical School of Communication University of Shanghai，Shanghai 210075，China
[Abstract] Objective To investigate the characteristics of the organisims of deep-venous catheter(DVC) tip culture and their antibiotics resistance. Menthods The culture results All 991 DVC tip were analyzed retrospectivly from January to December of 2010. Rusults Among 991 cather tip cultures,154(15.54%) were positive with 176 microorganisms： G+bacteria accounted for 41.47%,G-bacteria 36.36%,and yeasts22.17%.The fivemost common microorganisms were Staphylcoccus epidemidis(20.45%), Acinetobacter baumanii(15.34%), Staphylococcus aureus(11.93%),Candida albicans(11.36%) and Pseudomonas aeruginosa(6.25%). 94.12% of Staphylcoccus aureus were MRSA, 69.44% of Staphylcoccus epidemidis were MRScn.Kelbsiella pneumoniae，Pseudomonas areuginosa and Acinetobacter baumanni had an increasing tendency in drug-resistance and some of them were multiple drug-resistant. Conclusion The most common pathogens cultured from the DVC tip were drug-resistance.It’s key to regulation procedures of catheter placed and enforce medical attendance cathers and ethiological monitor for controlling the catheter-related infection.
[Key words] Nosocomial infection； Deep venous catheter；Ethology；Drug-resistance
深静脉导管(DVC)留置术已成为不可缺少的临床工具，方便了输液、输血、给药、营养支持及紧急抢救、血流动力学检测等。但随之而来的导管相关感染(CRI)也成为院内感染的主要原因之一，影响患者的预后，增加医疗成本，甚至威协着患者的生命。笔者回顾性分析了进修医院(上海瑞金医院)2010年DVC培养阳性的病原学及病案资料，为预防和治疗导管相关感染提供帮助。
1 资料与方法
1.1 数据资料
回顾性调查了进修医院2010年行DVC培养共991例次，对其中DVC培养阳性患者的临床资料及病原学填写调查表，了解导管尖端培养阳性的患者的临床表现。
1.2 标本采集方法
DVC口皮肤用氯已定消毒，用无菌剪刀剪下导管尖端5cm置无菌试管送检。
1.3 病原学鉴定和药敏
将DVC滚动接种在科玛嘉的血平板及真菌显色平板上，35℃孵育过夜，细菌鉴定采用梅里埃的VITEK2 Compact 进行鉴定，药敏按CLSI2009标准进行K-B法检测。用ATCC25922、ATCC25923、ATCC27853进行药敏质控。
2 结果
2.1 DVC病原菌的检出率及病原菌的构成情况
2010年全院共送检991例次DVC培养，其中培养阳性154例次，总阳性率15.54%。共培养出176株病原菌，其中G+、G-和真菌各占41.47%、36.36%和22.16%；G+菌以表皮葡萄球菌(20.45%)和金黄色葡萄球菌(11.93%)为主；G-菌以鲍曼不动杆菌(15.34%)、铜绿假单胞菌(6.25%)和肺炎克雷伯菌(4.54%)为主； 39株真菌以白色念珠菌(11.36%)为主。
2.2 176株病原菌的耐药性
2.2.1 常见G+菌的耐药 17株金黄色葡萄球菌16株(94.12%)为耐甲氧西林金葡菌(MRSA),对复方新诺明、磷霉素、利福平、优立新的耐药率分别为29.41%、11.76%、53.94%、47.06%；36株凝固酶阴性葡萄球菌中检出耐甲氧西林凝固酶阴性(MRScn)25株，占69.44%，对复方新诺明、磷霉素、利福平、优立新的耐药率分别为47.22%、13.89%、11.11%、13.89%；但包括肠球菌在内的三种常见G+球菌对万古霉素、替考拉宁和利那唑烷均高度敏感。, http://www.100md.com(郑爱兰 陈俊峰 韩立中)
[关键词] 医院感染；深静脉导管；病原学；耐药性
[中图分类号] R472.9 [文献标识码] B [文章编号] 1673-9701(2011)23-113-02
Descriptive Analysis on the Cases of 154 Deep Venous Cathgeter Tip Related Nosocomial Infection
ZHENG Ailan1 CHEN Junfeng2 HAN Lizhong3
1. Laboratory Department，Hui’an County Hospital of Quanzhou，Hui’an 362100，China； 2.B Type Ultrasonography Room，Hui’an County Hospital of Quanzhou，Hui’an 362100，China；3.Department of Microbiology，Ruijin Hospital Affiliated to Medical School of Communication University of Shanghai，Shanghai 210075，China
[Abstract] Objective To investigate the characteristics of the organisims of deep-venous catheter(DVC) tip culture and their antibiotics resistance. Menthods The culture results All 991 DVC tip were analyzed retrospectivly from January to December of 2010. Rusults Among 991 cather tip cultures,154(15.54%) were positive with 176 microorganisms： G+bacteria accounted for 41.47%,G-bacteria 36.36%,and yeasts22.17%.The fivemost common microorganisms were Staphylcoccus epidemidis(20.45%), Acinetobacter baumanii(15.34%), Staphylococcus aureus(11.93%),Candida albicans(11.36%) and Pseudomonas aeruginosa(6.25%). 94.12% of Staphylcoccus aureus were MRSA, 69.44% of Staphylcoccus epidemidis were MRScn.Kelbsiella pneumoniae，Pseudomonas areuginosa and Acinetobacter baumanni had an increasing tendency in drug-resistance and some of them were multiple drug-resistant. Conclusion The most common pathogens cultured from the DVC tip were drug-resistance.It’s key to regulation procedures of catheter placed and enforce medical attendance cathers and ethiological monitor for controlling the catheter-related infection.
[Key words] Nosocomial infection； Deep venous catheter；Ethology；Drug-resistance
深静脉导管(DVC)留置术已成为不可缺少的临床工具，方便了输液、输血、给药、营养支持及紧急抢救、血流动力学检测等。但随之而来的导管相关感染(CRI)也成为院内感染的主要原因之一，影响患者的预后，增加医疗成本，甚至威协着患者的生命。笔者回顾性分析了进修医院(上海瑞金医院)2010年DVC培养阳性的病原学及病案资料，为预防和治疗导管相关感染提供帮助。
1 资料与方法
1.1 数据资料
回顾性调查了进修医院2010年行DVC培养共991例次，对其中DVC培养阳性患者的临床资料及病原学填写调查表，了解导管尖端培养阳性的患者的临床表现。
1.2 标本采集方法
DVC口皮肤用氯已定消毒，用无菌剪刀剪下导管尖端5cm置无菌试管送检。
1.3 病原学鉴定和药敏
将DVC滚动接种在科玛嘉的血平板及真菌显色平板上，35℃孵育过夜，细菌鉴定采用梅里埃的VITEK2 Compact 进行鉴定，药敏按CLSI2009标准进行K-B法检测。用ATCC25922、ATCC25923、ATCC27853进行药敏质控。
2 结果
2.1 DVC病原菌的检出率及病原菌的构成情况
2010年全院共送检991例次DVC培养，其中培养阳性154例次，总阳性率15.54%。共培养出176株病原菌，其中G+、G-和真菌各占41.47%、36.36%和22.16%；G+菌以表皮葡萄球菌(20.45%)和金黄色葡萄球菌(11.93%)为主；G-菌以鲍曼不动杆菌(15.34%)、铜绿假单胞菌(6.25%)和肺炎克雷伯菌(4.54%)为主； 39株真菌以白色念珠菌(11.36%)为主。
2.2 176株病原菌的耐药性
2.2.1 常见G+菌的耐药 17株金黄色葡萄球菌16株(94.12%)为耐甲氧西林金葡菌(MRSA),对复方新诺明、磷霉素、利福平、优立新的耐药率分别为29.41%、11.76%、53.94%、47.06%；36株凝固酶阴性葡萄球菌中检出耐甲氧西林凝固酶阴性(MRScn)25株，占69.44%，对复方新诺明、磷霉素、利福平、优立新的耐药率分别为47.22%、13.89%、11.11%、13.89%；但包括肠球菌在内的三种常见G+球菌对万古霉素、替考拉宁和利那唑烷均高度敏感。, http://www.100md.com(郑爱兰 陈俊峰 韩立中)