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免疫缺陷患者院内革兰阳性球菌感染的流行病学及其耐药性研究
Epidemiological investigation of the nosocomial infection of gram-positive cocci in immunocompromised patients

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DOI:
作者:
张杏怡,袁园,周新,陈佰义,李群,丁星
Zhang xingyi,Yuan yuan,Zhou xin,Chen baiyi,Li qun,Ding xing
作者单位:
上海交通大学附属第一人民医院呼吸科
Department of Pulmonary Medicine,Shanghai First people’s Hospital, Shanghai Jiaotong University, Shanghai
关键词:
免疫抑制宿主；革兰阳性球菌；细菌耐药性监测
Immunocompromised hosts; Gram-positive cocci; Surveillance of bacterial resistance
摘要:
目的 本文研究通过对220例继发免疫缺陷合并医院内革兰阳性球菌感染的患者进行前瞻性研究，包括流行病学调查、临床表现、细菌学分布特点及其耐药性，为免疫缺陷患者院内革兰阳性球菌感染的经验性抗菌药物治疗提供临床依据。方法 在符合免疫缺陷标准的患者中，一旦细菌学评价患者革兰阳性球菌感染诊断成立即入选本研究，记录入选前3周患者的各项病史资料， 临床分离菌采用K-B 法按统一方案进行抗菌药物药敏试验。按CLSI 2008 版判断细菌鉴定及药物敏感性结果。结果 在入选的220例免疫缺陷患者中，革兰阳性球菌感染症状体征不典型，主要以发热为主。微生物学检查共分离出革兰阳性球菌237株，葡萄球菌属中甲氧西林耐药株对常见的抗菌药物的耐药率显著高于甲氧西林敏感株，未发现万古霉素、替考拉宁和利奈唑胺耐药株。金葡菌共98株，其中64.3%为MRSA；凝固酶阴性葡萄球菌共87株，其中MRCNS占71.3%；肠球菌共45株，其中粪肠球菌28株，余为屎肠球菌，粪肠球菌对多数测试药物的耐药率低于屎肠球菌，出现1株耐万古霉素的屎肠球菌，未发现对替考拉宁和利奈唑胺耐药菌株。　结论 免疫缺陷患者革兰阳性球菌感染临床表现多样，且革兰阳性球菌耐药性仍呈增长趋势，须及早采取防控措施。
Objective This study prospective investigate 220 cases with secondary immunodeficiency and nosocomial infection from gram-positive cocci, including clinical manifestations, Epidemiological investigation, analysis of bacterial resistance.Methods In the patients who meet a criterion of immunodeficiency, once the gram-positive cocci infection established by bacteriological evaluation, record the general situation, the type of immune deficiency, with or without invasive procedures, drug use of the patient within three weeks prior to the selection, record the current clinical signs and symptoms, related examinations, the results of bacteriology distribution and susceptibility test. Result 220 patients with secondary immunodeficiency, when nosocomial gram-positive cocci infection occur, usually the symptoms are not typical .237 gram-positive cocci were isolated, a total of 98 Staphylococcus aureu, in which MRSA account for 64.3% (63/98), a total 0f 87 Coagulase-negative staphylococci were detected, including MRCNS 62strains，account 71.3%. 45Enterococci were isolated, including 28 Enterococcus faecalis and 17 Enterococcus feces. 1 Enterococcus feces strain was resistant to Vancomycin. No strains resistant to teicoplanin and linezolid. Conclusions This study shows that the incidence of nosocomial gram-positive cocci infection in immunocompromised patients increased significantly and the bacteria have a high resistant rate to commom antibiotics. It is mandatory for hospitals to take and control effective measurements.

 

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