| ObjectTo investigate the distribution characteristics and drug resistance of the pathogenic bacteria of hospital-acquired bloodstream infection(HA-BSI)in intensive care unit(ICU)patients with acute poisoning,and to compare them with patients with non-acute poisoning.Analyze the distinctions,similarities and reasons between two groups as well as the differences in related factors.MethodsThis study was a single-center,retrospective,observational cohort study with a duration of 8 years.Clinical data of positive blood culture about inpatients admitted to ICU in our hospital from January 1,2010 to December 31,2017 were collected.According to whether HA-BSI patients were diagnosed with acute poisoning,they were divided into two groups: the poisoning group and the non-poisoning group.ResultsAmong the 368 patients with positive blood culture,there were 213 cases of HA-BSI,including 42 cases of acute poisoning in HA-BSI and 171 cases of non-acute poisoning in HA-BSI.A total of 550 bloodstream isolates were cultured from the 213 HA-BSI patients,among which 363 organisms(66.0%)were gram-negative bacteria,followed by 160 pathogens(29.1%)were gram-positive bacteria and 27 pathogens(4.9%)were fungi.The isolation rates of MDR,XDR and PDR were 36.9%,5.0%,3.6% respectively.A total of 89 bloodstream isolates were cultured from 42 HA-BSI patients with acute poisoning(poisoning group),and the number of gram-negative bacteria was 63(70.8%),the top three were Acinetobacter baumannii,Klebsiella pneumoniae and Pseudomonas aeruginosa,followed by 23pathogens(25.8%)were gram-positive bacteria includes Enterococcus faecium,Staphylococcus aureus and micrococcus,3 pathogens(3.4%)were fungi,mainly Candida glabrata.The isolation rates of MDR,XDR and PDR were 45.7%,8.6% and5.7%,respectively.A total of 461 organisms were isolated from the blood samples of171 HA-BSI patients with non-acute poisoning(non-poisoning group)and the highest proportion of gram-negative bacteria was 65.1%,followed by gram-positive bacteria(29.7%)and fungi(5.2%).The separation rates of MDR,XDR and PDR were 49.6%,11.6%,14.8% respectively.There were statistical differences in the distribution of the gram-negative bacteria(P = 0.000)of two groups.Further analysis showed that the proportion of Burkholderia cepacias and Klebsiella oxytocas in the poisoning group was higher than that in the non-poisoning group;The statistical differences of pathogen resistance between them(P = 0.020).Compared with the non-poisoning group,the proportion of non-MDR bacteria in the poisoning group was higher,while the proportion of PDR bacteria was lower.Compared with the clinical data and related factors between two groups,we found that statistical differences in distribution of gender and age,mechanical ventilation,deep vein catheter,drainage tube placement,blood purification,operation,coma,blood transfusion,use of immunosuppressants before bloodstream infection,underlying diseases and complications.Catheter insertion time and length of hospital stay in the non-poisoning group were longer than the poisoning group.Conclusion1.Gram-negative bacteria were the main pathogenic bacteria in HA-BSI patients with acute poisoning in ICU of our hospital.Acinetobacter baumannii,Klebsiella pneumoniae and Pseudomonas aeruginosa were the top three,followed by Gram-positive bacteria,includes Enterococcus faecium,Staphylococcus aureus and micrococcus,a small number of fungi,mainly Candida glabrata.2.By comparing the pathogenic bacteria of bloodstream infection between the poisoning group and the non-poisoning group,it was found that the pathogenic bacteria spectrum of bloodstream infection in the poisoning group was approximately the same as that in the non-poisoning group,but there was a slight difference in the distribution of Gram-negative bacteria.The first two pathogens in the non-poisoninggroup were the same as those in the poisoning group,but the third was E.coli.The proportion of Burkholderia cepacia and Klebsiella oxytoca in the poisoning group was higher than that in the non-poisoning group.3.Drug resistance: XDR and PDR were more likely to occur in gram-negative bacteria than in gram-positive bacteria in HA-BSI patients with acute poisoning,and the proportion of non-MDR bacteria in the toxic group was higher,and PDR bacteria was lower than that in the non-poisoning group.4.The clinical data and related factors were compared and analyzed.It was found that the blood purification,the catheterization rate of deep vein and the use of immunosuppressants in the poisoning group were higher than those in the non-poisoning group.This may partly explain the high rate of conditional pathogen Burkholderia cepacia and Klebsiella oxytoca infection.The patients in the non-toxic group were older,the basic diseases were more complex,the catheterization time of each catheter was longer,and the hospitalization time was longer.This may be related to the higher incidence of PDR bacteria. |
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