| Objectives Through analyzing the invasion and pathogenic characteristics of bacteria from 713 cases of bloodstream infection,find the invasion pathways of the bacteria,as well as the source of the infection,thereby reducing the incidence of bloodstream infection and mortality rates by cutting off the infection source.At the same time,analyze the distribution of bacteria,the characteristics of drug resistance and resistance phenotype of bloodstream infection pathogens to guide reasonable clinical prescription and reduce the incidence of drug-resistance.Provide the basis for clinical prevention and treatment of bloodstream infections.Methods On a daily basis,collect the blood culture positive case pathogens in our hospital lab from January 2015 to December 2016.Conduct the pathogen identification and drug susceptibility test with the BD Phoenix-100 automatic microbial identification system.Meanwhile,understand patients' conditions,the characteristics of the pathogenic bacteria,clinical drug resistance and the composition of pathogenic bacteria.Find out the source of pathogenic bacteria in bloodstream infection with further analysis of pathogens and departmental distribution,combined with laboratory tests and the characteristics of pathogenic invasion.The infection strains were the same as those of the blood culture,and except for other sources of infection.then we considered that the focus of infection is the source of bloodstream infection.Results 1 The source of pathogens in bloodstream infection: A total of 713 pathogens were detected in two years in bloodstream infection.The detection rate of the first five isolates were Escherichia coli(17.8%),Klebsiella pneumoniae(16.3%),coagulase negative staphylococci(10.9%),Acinetobacter baumannii(7.9%)and Staphylococcus aureus(7.7%).257 strains(36.0%)were detected from the venous catheters,of which 226 come from the central venous catheters.The main pathogenic bacteria of venous catheter were coagulase negative staphylococcus(72 strains)and Acinetobacter baumannii(55strains),the majority of such cases came from the Intensive Care Unit(ICU)and the Neurosurgery Department.Pathogenic bacteria of bloodstream infections which from urinary tract infection contain 146 strains(20.5%).Escherichia coli(70 strains)are the main bacteria,and the main distribution Department is ICU,Urology Department and Nephrology Department.There were 114 bloodstream infection pathogens from abdominal infection(16%),mainly Enterobacteriaceae and streptococcus.ICU and General Surgery are the main sources of such strains.There were 80 strains of lower respiratory tract infection(11.2%),mainly Streptococcus pneumoniae(35 strains).The main source is the Respiratory Medicine Department.There were 61 strains(8.6%)of bloodstream infection pathogens from Traumatic Infection,mainly Staphylococcus aureus(39 strains)and the main source is the Orthopedics Department.Besides,there were 55 other unknown routes of bloodstream infection(7.7%).2 Drug sensitivity results: In the gram negative bacteria,Escherichia coli and Klebsiella pneumoniae have a high resistance to cephalosporins and quinolones,but they are sensitive to carbapenems,aminoglycosides and enzyme inhibitors.Besides,the resistance rate of Klebsiella pneumoniae was higher than that of Escherichia coli,and the difference was statistically significant(P<0.01).Acinetobacter baumannii with a high resistance rate to variety of antibiotics.Burkholderia cepacia was more sensitive to ceftazidime,piperacillin/tazobactam,compound sulfamethoxazole,cefepime,and so on.And Pseudomonas aeruginosa was resistant to the first and two generation cephalosporins and the natural resistance to sulfamethoxazole,and was sensitive to ceftazidime,piperacillin/tazobactam,aminoglycosides.For gram positive bacteria,the resistance to penicillin from Staphylococcus aureus was as high as 96.5%.Enterococci are sensitive to penicillin and ampicillin.At the same time,four kinds of common positive bacteria were sensitive to linezolid,vancomycin and teicoplanin.There were 97 cases of multidrug resistance in 713 pathogens of bloodstream infection,and the detection rate was13.6%.Among them,there were 47(48.5%)of Enterobacteriaceae producing carbapenemase,37 strains(38.1%)of Multidrug resistant Acinetobacter baumannii,10strains(10.3%)of methicillin-resistant Staphylococcus aureus,and 3 strains(3.1%)of Multidrug resistant Pseudomonas aeruginosa.These multidrug resistant bacteria were mainly isolated from the ICU,the Neurological Intensive Ward and the Neurosurgery Department.Whether positive or negative bacteria,urinary pathogen resistance rate was slightly higher than that of the blood,but the difference was not statistically significant(P>0.05).And the drug resistance of pathogenic bacteria in the sputum resistance rate was significantly higher than that of urine and blood sample rate,the difference was statistically significant(P<0.05).Conclusions 1 The top five pathogens isolates with the highest detection rate in bloodstream infection were Escherichia coli,Klebsiella pneumoniae,coagulase negative staphylococcus,Acinetobacter baumannii and Staphylococcus aureus.2 The main route of infection of the pathogen was venous catheter.Coagulase negative staphylococci and Acinetobacter baumannii comprised the majority of the pathogens.Pathogenic bacteria of bloodstream infection which from urinary tract infection was mainly Escherichia coli,and the main distribution department is the ICU,the Urology Department and the Nephrology Department.Pathogenic bacteria of bloodstream infection which from abdominal infection were mainly Enterobacteriaceae and streptococcus.The ICU and the General Surgery Department are the main detection department.Pathogens from lower respiratory tract infections were mainly Streptococcus pneumoniae invasion to blood circulation,and the main distribution department is the Respiratory Medicine Department;Staphylococcus aureus is the main pathogen causing bloodstream infection through trauma infection and it is mainly from the Department of Orthopedics.3 Whether positive or negative bacteria,urinary pathogen resistance rate was slightly higher than that in the blood,but the difference was not statistically significant.Drug resistance of pathogenic bacteria in the sputum was significantly higher than that from the urine and the blood.The difference was statistically significant.Containing blood infections needs to focus on the search for the source of dissemination,active treatment of infection source.Control and reduce the incidence of bloodstream infections. |
PDF Full Text Request