目的 分析临沧市人民医院2019—2022年肾脏免疫风湿科血液透析患者导管相关性血流感染病原菌分布及耐药性，为临床合理预防及治疗导管相关性血流感染提供参考。方法 搜集2019—2022年临沧市人民医院肾脏免疫风湿科送检的发生导管相关性血流感染的血液透析患者的血标本，对其病原菌分布及耐药性进行统计分析。结果 共检出病原菌160株，其中以革兰阳性菌为主，共91株（占56.9%），常见的是表皮葡萄球菌和金黄色葡萄球菌；革兰阴性菌共69株（占43.1%），常见的是铜绿假单胞菌、大肠埃希菌、嗜麦芽窄食单胞菌和阴沟肠杆菌。表皮葡萄球菌中对甲氧西林耐药的菌株检出率及对青霉素耐药率均高于金黄色葡萄球菌，均未检出对万古霉素和利奈唑胺耐药的菌株。大肠埃希菌中产超广谱β-内酰胺酶（ESBL）检出率为33.3%，低于全国水平；阴沟肠杆菌对所监测的抗菌药物的敏感性较好。铜绿假单胞菌对绝大多数抗铜绿假单胞菌药物的敏感性较好；嗜麦芽窄食单胞菌对米诺环素和复方磺胺甲噁唑的敏感性均大于80%，对替卡西林/克拉维酸、米诺环素无耐药菌株。结论 临沧市人民医院血液透析患者导管相关性血流感染细菌以革兰阳性菌为主。各病原菌对临床常用抗菌药物的耐药性各有不同，应根据各病原菌的耐药特点和抗菌药物药物的药动学/药效学选择合适的抗感染药物，并及时送检微生物培养。

Objective To analyze the detection and drug resistance rate of pathogens associated with catheter-related bloodstream infection in hemodialysis patients in the Department of Renal Immunology and Rheumatology of Lincang People’s Hospital from 2019 to 2022, and to provide reference for clinical rational prevention and treatment of catheter-related bloodstream infection. Methods Blood samples of hemodialysis patients with catheter-associated bloodstream infection were collected from the Department of Renal Immunology and Rheumatology of Lincang People’s Hospital from 2019 to 2022, and the detection and drug resistance rate of pathogenic bacteria were analyzed statistically. Results A total of 160 strains of pathogenic bacteria were detected, of which 91 strains (56.9%) were gram-positive bacteria, and Staphylococcus epidermidis and Staphylococcus aureus were the most common. There were 69 strains of gram-negative bacteria (43.1%), and the most common were Pseudomonas aeruginosa, Escherichia coli, Stenotrophomonas maltophilia and Enterobacter cloacae. The detection rate of methicillin-resistant strains and penicillin resistance rate of Staphylococcus epidermidis were higher than that of Staphylococcus aureus, and no vancomycin and linezolidin-resistant strains were detected. The detection rate of ESBL in Escherichia coli was 33.3%, lower than the national level. The sensitivity of Enterobacter cloacae to the monitored antibiotics was better. Pseudomonas aeruginosa is sensitive to most anti-Pseudomonas aeruginosa drugs. The sensitivity of Stenotrophomonas maltophilia to minocycline and compound sulfamethoxazole was more than 80%, and there was no resistance to ticacillin/clavulanic acid or minocycline. Conclusion Gram-positive bacteria were the main bacteria of catheter-associated bloodstream infection in hemodialysis patients in Lincang People’s Hospital. Each pathogen has different drug resistance to commonly used antibiotics in clinical practice. Appropriate anti-infective drugs should be selected according to the resistance characteristics of each pathogen and PK/PD of antibiotics, and sent to microbial culture in time.

R978.1

临沧市人民医院科技计划项目(2018-29);临沧市科技创新团队项目(202204AC100002-TD04)