摘要
目的研究心脏机械瓣膜置换术后切口感染金黄色葡萄球菌流行病学,指导临床治疗。方法收集535例接受心脏机械瓣膜置换术的患者临床资料,检测患者感染病原菌类型。采用K-B法分析菌株耐药性,并用PCR检测金黄色葡萄球菌的耐药基因。结果 535例调查患者中,感染患者104例,感染率为19.44%。其中,男、女性感染率为18.43%和20.66%。住院时间≥15 d和<15 d患者感染率为24.88%和15.84%。合理使用、不合理使用抗菌药物患者感染率为15.11%和24.12%。合并骨髓炎、不合并骨髓炎患者感染率为23.51%和15.85%。104例感染者中分离出77株病原菌,其中革兰阳性菌、革兰阴性菌和真菌分别为40、35和2株。金黄色葡萄球菌27株,表皮葡萄球菌9株,其他革兰阳性菌4株;鲍曼不动杆菌15株,铜绿假单胞菌11株,大肠埃希菌5株,其他革兰阴性菌4株。27株金黄色葡萄球菌对克拉霉素、诺氟沙星、环丙沙星、头孢唑啉、氨苄西林的耐药率分别为14.81%、33.33%、22.22%、51.85%和62.96%,未产生对万古霉素耐药。27株金黄色葡萄球菌株中,耐甲氧西林金黄色葡萄球菌(MRSA) 16株,甲氧西林敏感金黄色葡萄球菌(MSSA) 11株。MRSA中同时检测到erm+mecA基因、aac(6’)/aph(2’’)+erm+mecA基因、aac(6’)/aph(2’’)+aph(3’)基因、aac(6’)/aph(2’’)+aph(3’)+erm+mecA基因的有13、10、8和3株。MSSA中同时检测到erm+mecA基因、aac(6’)/aph(2’’)+erm+mecA基因、aac(6’)/aph(2’’)+aph(3’)基因的有6、4和7株,未发现同时检测到aac(6’)/aph(2’’)+aph(3’)+erm+mecA基因的MSSA。结论金黄色葡萄球菌是心脏机械瓣膜置换术后切口感染主要病原菌,临床治疗可优先考虑万古霉素,应高度重视MRSA的多药耐药问题。
Objectives To study the epidemiology of Staphylococcus aureus infection after mechanical heart valve replacement in order to guide its clinical treatment.Methods Clinical data on 535 patients undergoing mechanical heart valve replacement were collected to detect the type of pathogenic bacteria.The K-B method was used to analyze the drug resistance of S.aureus.Significant differences were analyzed statistically.Results Of 535 patients studied,104 had an infection,for a rate of infection of 19.44%.The rate of infection was 18.43%in male patients and 20.66%in female patients.The rate of infection was 24.88%for patients with a duration of hospitalization>15 days and 15.84%for patients with a duration<15 days.The rate of infection was 15.11%when antibiotics were rationally used and 24.12%when antibiotics were not rationally used.The rate of infection was 23.51%in patients with osteomyelitis and 15.85%in patients without osteomyelitis.Seventy-seven strains of pathogens were isolated from 104 patients,including 40 strains of Gram-positive bacteria,35 strains of Gram-negative bacteria,and 2 strains of fungi.The Gram-positive bacteria included 27 strains of S.aureus,9 strains of S.epidermidis,and 4 strains of other Gram-positive bacteria.The Gram-negative bacteria included 15 strains of Acinetobacter baumannii,11 strains of Pseudomonas aeruginosa,5 strains of Escherichia coli,and 4 strains of other Gram-negative bacteria.Twenty-seven strains of S.aureus were resistant to clarithromycin at a rate of 14.81%,to norfloxacin at a rate of 33.33%,to ciprofloxacin at a rate of 22.22%,to cefazolin at a rate of 51.85%,and to ampicillin at a rate of 62.96%.No strains were resistant to vancomycin.Of the 27 strains of S.aureus,16 were methicillin-resistant S.aureus(MRSA)and 11 were methicillin-sensitive S.aureus(MSSA).The erm+mecA genes were detected in 13 strains of MRSA,the aac(6’)/aph(2’)+erm+mecA genes were detected in 10,the aac(6’)/aph(2’)+aph(3’)genes were detected in 8,and the aac(6’)/aph(2’)+aph(3’)+erm+mecA g
作者
易一乐
万艳平
YI Yi-le;WAN Yan-ping(Cardiac Surgery,Guizhou Provincial People's Hospital,Guiyang,China 550002;University of South China)
出处
《中国病原生物学杂志》
CSCD
北大核心
2019年第8期967-970,共4页
Journal of Pathogen Biology
关键词
心脏机械瓣膜置换术
感染
流行病学
耐药基因
Mechanical valve replacement surgery
infection
epidemiological study
drug resistance genes
