目的   通过对急性深静脉血栓形成（DVT）患者经导管接触性溶栓治疗（CDT）中，影响血管导管相关感染（VCAI）危险因素及病原菌分析，为VCAI的预防提供合理、有效的措施。方法   收集2019年1月—2022年12月徐州市肿瘤医院介入科行CDT治疗的急性DVT患者的临床资料，回顾性调查患者诊疗相关资料及血培养结果，并对发生VCAI和病原菌情况进行分析。结果   本研究共调查急性DVT行CDT治疗的患者437例，发生VCAI的患者共21例，千日感染率为0.543‰。多因素Logistic回归分析结果显示：溶栓频率＞3次/天［OR=3.49（95%CI：1.86~6.45）］、导管留置时间＞7 d［OR=3.86（95%CI：1.26~10.18）］和有导管回送［OR=8.67（95%CI：4.83~12.65）］是患者发生VCAI的危险因素（P＜0.05）。发生VCAI的21例患者，血培养共培养出24株病原菌，有3例患者出现复合病原菌感染情况。其中以革兰阳性球菌最为常见，共培养出13株，占比54.17%，革兰阴性菌9株，占比37.5 %。结论   导管留置时间＞7 d、溶栓频率＞3次/天和有导管回送是急性DVT患者CDT治疗中发生VCAI的危险因素。VCAI的病原菌以单一病原菌为主，可合并其他病原菌感染，其中以革兰阳性球菌为主。

        Objective  By analyzing the risk factors and pathogens of vessel catheter associated infection（VCAI）in patients with acute deep vein thrombosis（DVT）undergoing catheter directed thrombolysis（CDT），to provide  reasonable and effective measures for the prevention and treatment of VCAI ．Methods  Clinical data of patients undergoing CDT treatment for acute DVT in the interventional department of the hospital from January 2019 to December 2022 was collected，patient diagnosis and treatment related data and blood culture results were retrospectively investigated and organized，and the occurrence of VCAI and pathogenic bacteria was statistically analyzed．Results  This study investigated 437 patients undergoing CDT treatment for acute DVT，and a total of 21 patients developed VCAI，with an infection rate of 0.543‰．The  results of multiple Logistic  regression analysis show that thrombolysis frequency＞3 times/day（OR=3.49［95%CI：1.86-6.45］），catheter retention days＞7 days（OR=3.86［95%CI：1.26-10.18］），and the presence of catheter return（OR=8.67［95%CI：4.83-12.65］） were risk factors for the occurrence of VCAI in patients．Among the 21 patients with VCAI，a total of 24 strains of pathogenic bacteria were discoveredin blood culture，and 3 patients developed composite pathogen infections．Among them，Gram  positive cocci were the most common，with a total of 13 strains cultured，accounting for 54.17%，9 strains of Gram negative bacteria，accounting for 37.5%．Conclusions  The duration of catheter retention＞7 days，thrombolysis frequency＞3 times/day，and the presence of catheter return are risk factors for VCAI in acute DVT patients undergoing CDT treatment．The pathogen of VCAI is mainly single pathogen，which can be combined with other pathogens，among which Gram positive cocci are the main pathogen．

目的 分析接受永久性膀胱造瘘男性患者相关尿标本病原菌学分布特点及耐药性,进一步为药物防治导管伴随性尿路感染提供科学依据。方法 回顾性分析2019年1月—2021年8月我院收治的368例接受永久性膀胱造瘘男性患者尿标本病原菌分离培养结果,观察其病原菌构成和分布特征,进一步分析相关耐药性。结果 (1)本组接受永久性膀胱造瘘男性患者共368例,尿培养阳性316例,阳性率85.87%(316/368);共分离出病原菌112株,分离率30.43%(112/368),其中革兰阴性菌80株,占71.43%(80/112),以大肠埃希菌、铜绿假单胞菌为主;革兰阳性菌31株,占27.68%(31/112),以表皮葡萄球菌、粪肠球菌为主;真菌1株,占0.89%(1/112)。(2)大肠埃希菌对氨苄西林耐药率66.67%、哌拉西林64.71%、头孢曲松60.78%、头孢他啶60.78%、环丙沙星62.75%,对青霉素耐药率较低,仅为5.88%,对亚胺培南和美罗培南的耐药性为0。铜绿假单胞菌对氨苄西林、头孢噻肟完全耐药,耐药率高达100.00%;对头孢曲松83.33%、哌拉西林72.20%、头孢他啶72.22%;对庆大霉素的耐药率较低,仅为16.67%,对亚胺培南、美罗培南无耐药性。(3)表皮葡萄球菌对氨苄西林耐药性和青霉素的耐药性均为100.00%;对哌拉西林、头孢曲松、头孢噻肟耐药率＞60%;对磺胺甲噁唑／甲氧苄啶的耐药率较低,仅为12.50%,对万古霉素无耐药性。粪肠球菌对庆大霉素完全耐药,耐药率为100.00%;对头孢曲松、环丙沙星、左氧氟沙星、红霉素的耐药率＞60.00%;对头孢他啶的耐药性较低,耐药率仅为25.00%,对青霉素、万古霉素无耐药性。结论 永久性膀胱造瘘患者病原菌主要是大肠埃希菌、铜绿假单胞菌等革兰阴性菌,革兰阳性菌以表皮葡萄球菌为主,对于不同抗菌药物的耐药性差异较大。

目的 分析高龄呼吸道感染患者病原菌检测结果及耐药性情况,总结高龄呼吸道感染患者抗菌药物的合理用药经验。方法 对我院2018年1月—2020年12月收治的784例高龄呼吸道感染患者痰液标本进行病原菌培养及药敏试验,统计分析检测结果。结果 701株病原菌中,革兰阴性(G-)菌、革兰阳性(G+)菌和真菌分别检出497株、136株和68株,分别占70.90%、19.40%和9.70%。G-菌以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌和奇异变形杆菌为主,分别占21.97%(154株)、18.97%(133株)、14.98%(105株)和7.13%(50株),G+菌以金黄色葡萄球菌为主,占11.27%(79株)。G-菌耐药性前五位依次为氨苄西林、哌拉西林、复方磺胺甲噁唑、头孢唑啉和头孢他啶,耐药率依次为95.96%、85.11%、79.88%、77.06%和52.92%。G+菌耐药性前五位依次为青霉素、氨苄西林、红霉素、环丙沙星和复方磺胺甲噁唑,耐药率依次为95.59%、89.71%、84.56%、80.15%和75.00%。结论 高龄呼吸道感染患者病原菌构成以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、奇异变形杆菌和金黄色葡萄球菌为主,G-菌对氨苄西林、哌拉西林、复方磺胺甲噁唑、头孢唑啉和头孢他啶耐药最强,G+菌对青霉素、氨苄西林、红霉素、环丙沙星和复方磺胺甲噁唑最强,且呈多重耐药特征,加强临床耐药性监测有助于指导合理用药。

Objective To analyze the test results and drug resistance of pathogenic bacteria in elderly patients with respiratory tract infections, and summarize the rational use of antibiotics in elderly patients with respiratory tract infections. Methods The sputum samples of 784 elderly patients with respiratory tract infections admitted to our hospital from January 2018 to December 2020 were collected for pathogen culture and drug sensitivity test, and the test results were statistically analyzed. Results Among 701 strains of pathogenic bacteria, 497 strains were Gram-negative (G-) bacteria (70.90%), 136 strains were Gram-positive (G+) bacteria (19.40%) and 68 strains were fungi (9.70%). G-bacteria were mainly Klebsiellapneumoniae, Pseudomonas aeruginosa, Escherichia coli and Proteus mirabilis, accounting for 21.97% (154 strains), 18.97% (133 strains), 14.98% (105 strains) and 7.13% (50 strains). G+bacteria were mainly Staphylococcus aureus, accounting for 11.27% (79 strains). The top five antibiotics which G-bacteria resisted were ampicillin, piperacillin, compound sulfamethoxazole, cefazolin and ceftazidime.The resistance rates were 95.96%, 85.11%, 79.88%, 77.06% and 52.92%,respectively. The top five antibiotics which G+bacteria resisted were penicillin, ampicillin, erythromycin, ciprofloxacin and compound sulfamethoxazole, and the drug resistance rates were 95.59%, 89.71%, 84.56%, 80.15% and 75.00%, respectively. Conclusions The pathogenic bacteria in elderly patients with respiratory tract infections were mainly Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis and Staphylococcus aureus. G-bacteria resisted ampicillin, piperacillin,compound sulfamethoxazole, cefazolin and ceftazidime the most. G+bacteria were most resistant to penicillin, ampicillin, erythromycin, ciprofloxacin and compound sulfamethoxazole, and were characterized by multi-drug resistance.Enhancing bacterial resistance monitoring helps guiding the rational use of drugs.

目的 了解广东地区糖尿病足患者创面病原菌分布及耐药性变迁。方法 回顾性分析A组(2010年1月—2014年12月就诊的糖尿病足患者)和B组(2015年1月—2018年1月就诊的糖尿病足患者)研究者创面病原菌分布及耐药性变迁。结果 B组中创面G⁺菌及G^-菌均有下降趋势且G^-菌下降较快,细菌种类明显增加,真菌及混合感染明显上升,A组以金黄色葡萄球菌、铜绿假单胞菌、大肠埃希菌感染为主;B组以金黄色葡萄球菌、奇异变形杆菌、铜绿假单胞菌及真菌感染为主;B组相对于A组的细菌耐药性增加。结论 近年来糖尿病足患者病原菌种类明显增加且混合感染及真菌感染上升,且其耐药性增加,因此早期经验用药而后根据药敏选择抗菌药物治疗是糖尿病足感染治疗的关键。

Objective To investigate the distribution and drug resistance of pathogenic bacteria in diabetic foot wounds in Guangdong area. Methods Patients with diagnosis of diabetic foot between group A (from Jan 2010~Dec 2014 ) and group B (from Jan 2015 to Jan 2018) were retrospectively analyzed. We studied the bacteria distribution and drug resistance of pathogenic changes of group A and group B. Results In group B, both G+ and G- bacteria had a decreased trend while G- bacteria decreased rapidly, but the species of bacteria increased obviously just as fungi and mixed infection increased obviously. Bacteria infection in group A were mainly about Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli wihle group B were Staphylococcus aureus, Proteus mirabilis, Aeruginosa and Fungal infection; the resistance of group B to A was lower. Conclusion In recent years, kinds of pathogenic bacteria of diabetic foot were significantly increased and the mixed infection and increased fungal infection as well as its drug resistance increased, so the early experience of medication choice of antibiotics based on drug sensitivity and treatment are the key to the treatment of diabetic foot infection.

目的 分析我院2011—2015年我院儿科住院患者下呼吸道病原菌分布及其耐药性。方法 采用全自动生化鉴定仪对痰标本分离株进行鉴定,用全自动微生物药敏系统和纸片扩散法对病原菌的耐药性进行检测,并用头孢硝噻吩纸片法对β-内酰胺酶进行检测。结果 2011—2015年共分离得到下呼吸道病原菌518株,包括肺炎链球菌(21.62%)、金黄色葡萄球菌(16.99%)、流感嗜血杆菌(14.48%)、肺炎克雷伯菌(11.97%)、大肠埃希菌(8.11%)、卡他莫拉菌(5.41%)、鲍曼不动杆菌(3.86%)和铜绿假单胞菌(3.86%)等。药敏结果显示,肺炎链球菌对克林霉素(90.18%)、红霉素(92.86%)和复方新诺明(87.50%)的耐药率较高,金黄色葡萄球菌则对青霉素G(90.91%)和红霉素(68.18%)有较强耐药性,未发现对万古霉素或利奈唑胺耐药的革兰阳性球菌。流感嗜血杆菌对氨苄西林耐药率为32%,与其β-内酰胺酶阳性率较一致,肺炎克雷伯菌和大肠埃希菌对头孢类药物(17.33%~45.33%)和喹诺酮类药物(34.67%~50.67%)耐药性较高,并发现1株碳青霉烯耐药的肺炎克雷伯菌。结论 本院下呼吸道感染病原菌谱较广,主要包括多种革兰阳性球菌和革兰阴性杆菌,并对多种抗菌药物表现出较强耐药性,临床应注重合理应用相关抗生素,严格防控病原菌的医院感染及传播。

Objective To analyze the antimicrobial resistance and the profile of pathogens from lower respiratory tract infections in pediatric in patients. Methods Sputum bacterial isolates were identified by an automated biochemical identification system. Antimicrobial resistance was detected by an automated drug susceptibility detection system and the disc diffusion method. The β-lactamases was tested by the nitrocefin disc detection method. Results Five hundred and eighteen bacterial pathogens were isolated from sputum samples during 2011-2015, including streptococcus pneumoniae(21.62%), staphylococcus aureus(16.99%), haemophillus influenzae(14.48%), klebsiella pneumoniae(11.97%), escherichia coli(8.11%), moraxelle catarrhalis(3.8%), acinetobacter baumanii(3.86%) and pseudomonas aeruginosa(3.86%). High resistant rates were detected for S. pneumoniae to clindamycin(90.18%), erythromycin(92.86%) and sulfamethoxazole (85.50%), while S. aureus was highly resistant to penicillin G(90.91%) and erythromycin(68.18%). Resistance to vancomycin and linezolid was not detected for gram positive cocci. The resistant rate to ampicillin was 32% for H. influenzae, which was in concordance with the production of β-lactamases. Relatively high resistance was detected for K. pneumoniae and E. coli to cephalosporins and quinolones. A carbapenem-resistant K. pneumoniae isolate was also detected. Conclusion Multiple bacterial species were isolated from lower respiratory tract infections in our hospital, including different species of gram positive cocci and gram negative bacilli, and these isolates exhibited high resistance to antibiotics tested. The clinical use of antibiotics and hospital infection and transmission of these pathogens should be controlled.

目的 研究探讨重症监护病房(ICU)病原菌的分布及耐药情况,为临床合理使用抗菌药物提供科学依据。方法 回顾性分析2015年ICU住院患者送检细菌分离培养及药敏试验结果。结果 ICU共送检标本1 326份,分离出病原菌554株,其中革兰阴性病原菌462株(83.4%),革兰阳性病原菌48株(8.7%),真菌44株(7.9%)。革兰阴性杆菌前5位依次为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、粘质沙雷菌和大肠埃希菌,且多耐药菌株比例较高。革兰阳性病原菌以金黄色葡萄球菌为主,32株(66.7%),MRSA检出率78.3%(25/32)。结论 加强重症监护病房的细菌及药敏监测,根据病原菌药敏结果指导临床合理使用抗菌药物,控制耐药菌株的产生,预防及控制院内感染及感染暴发。

Objective To investigate the distribution characteristics and drug resistance of pathogenic bacteria in intensive care unit(ICU) and provide scientific evidence for clinically reasonable use of antibiotics. Methods Specimens from hospitalized intensive care unit patients in 2015 were obtained for routine bacterial isolation and culture. Results A total of 554 bacterial strains were isolated from 1326 specimens, in which Gram-negative bacilli accounted for 462 stains (83.4%),Gram-positive cocci accounted for 48 stains (8.7%),and fungi accounted for 44 stains (7.9%). Gram-negative bacilli of the top five were Acinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumoniae, Serratia marcescens and Escherichia coli,and the rate of multiple resistant bacteria was relatively high.Staphylococcus aureus were the main Gram-positive cocci, including MRSA accounted for 78.3%(25/32). Conclusion The monitoring of ICU clinical pathogens and their resistance should be strengthened. It is a great significance to use antibiotics rationally according to the results of susceptibility testing, in order to control the occurrence of resistant bacteria , prevent and control hospital infection and infection outbreak.

目的 探讨本中心引起儿童泌尿系统感染的常见病原菌的分布以及耐药情况,为临床合理选用抗菌药物提供参考。方法 回顾性分析本医疗中心2012年1月—2013年12月2463例泌尿系统感染患儿中段尿标本培养及药敏检测结果。结果 2463例患儿中段尿标本共培养病原菌479株,阳性率为19.45%。其中革兰阴性杆菌309株(64.51%),革兰阳性球菌138株(28.81%),真菌32株(6.68%,主要为白假丝酵母菌)。分离率前7位的病原菌依次为大肠埃希菌(36.53%)、肺炎克雷伯菌(12.73%)、粪肠球菌(D群)(12.32%)、屎肠球菌(D群)(10.23%)、真菌(6.68%)、铜绿假单胞菌(5.22%)、奇异变形菌(3.13%),革兰氏阴性杆菌以大肠埃希菌和肺炎克雷伯菌为主,其中产超广谱β‐内酰胺酶菌株125株,比例高达71.42%;革兰阳性球菌以肠球菌(D群)为主,金黄色葡萄球菌检出率为2.30%,其中耐甲氧西林株占27.27%。结论 大肠埃希菌仍为儿童泌尿系统感染的主要病原菌,且存在多重耐药菌感染情况,革兰氏阳性球菌有增多的趋势;明确病原菌种类及药敏结果,对临床合理应用抗菌药物治疗儿童泌尿系统感染有重要意义。

Objective To research the distribution of common pathogenic bacteria and drug resistance of urinary tract infection in the hospital for providing reference of antimicrobial drugs for clinical reference. Methods Pathogenic bacteria isolated from the germiculture positive specimens of midstream urine and the antimicrobial susceptibility test results from Jan 2012 to Dec 2013 in our hospital were retrospective summarized. Results 479 strains pathogenic bacteria were isolated from 2463 urine samples totally. The positive rate was 17.3％, with 309 strains of gram-negative bacilli (64.51％),138 strains of gram-positive coccus(28.81％),32 strains of fungi(6.68％).The top 7 isolation of pathogens were strains of escherichia coli(36.53％),strains of klebsiella pneumoniae(12.73％),strains of enterococcus faecalis D group(12.32％),strains of enterococcus faecium D group(10.23％),strains of fungi(6.68％),strains of pseudomonas aeruginosa(5.22％),strains of staphylococcus epidermidis(3.13％).125 strains of klebsiella pneumoniae produced ESBL were detected out with the rates of up to 71.42%. The strains of gram-negative bacteria were based on enterococcus faecalis (D group),yet staphylococcus aureus methicillin resistant strains accounted for 27.27%. Conclusion Escherichia coli is the main pathogenic bacteria of child urinary tract infection and the multidrug resistance of the pathogenic bacteria is in a very serious situation. And gram-positive cocci is going to be increasing. It is necessary to make clear pathogens and drug sensitivity results, which is important to guide clinic make use of antibacterial agents exactly to cure infection of urinary system in children.