Analysis of Pathogenic Characteristics and Clinical Features of Patients with Bloodstream Infection in a “Third Grade Class A”Hospital in Baotou in 2016-2018 / 中国药房

ABSTRACT

OBJECTIVE： To analyze the pathogenic characteristics and clinical features of patients with bloodstream infection in the First Affiliated Hospital of Baotou Medical College so as to provide reference for anti-infective treatment. METHODS： The positive rate of 6 052 blood culture specimens in our hospital collected during Jan 1st， 2016-Dec. 31st， 2018 were counted by retrospective study. WHONET 5.6 software was used to analyze clinical department， the distribution and drug resistance of pathogenic bacteria. The clinical data of 447 inpatients with bloodstream infection were collected in respect of gender， age， underlying disease， invasive operation， length of stay and prognosis （cured， uncured， dead）. The patients were divided into two groups according to community acquired blood flow infection （CABSI） and hospital acquired blood flow infection （HABSI）. The differences of the above clinical data between the two groups were analyzed by χ2 test. RESULTS： Total positive rate of     6 052 blood culture samples were 10.3％ （623/6 052）. The blood culture pathogens mainly came from infectious disease department （12.0％， 76/623）， nephrology department （11.4％， 71/623）， hematology department （10.8％， 67/623）， surgery department （10.1％， 63/623）. Of 623 strains of pathogens， Gram- negative bacteria accounted for 49.3％， Gram-positive bacteria accounted for 49.3％， and fungi accounted for 1.4％. The top six pathogens were Coagulase-negative Staphylococcus （36.5％）， E. coli （26.6％）， K. pneumoniae （13.0％）， S. aureus （5.8％）， Enterococcus （5.8％） and P. aeruginosa （2.9％）. The detection rate of MRCNS was 75.3％ in Coagulase-negative Staphylococcus （171/227） and that of MRSA was 25.0％ in S. aureus （9/36）， respectively. The sensitivity rate of Staphylococcus to rifampicin was higher than 90.0％， and the drug resistance rates of Enterococcus to penicillin G， ampicillin， high concentration of gentamicin， ciprofloxacin， levoflox acin and erythromycin were higher than or equal to 50.0％. No vancomycin-resistant gram positive bacteria were found. The prevalence of ESBLs-producing strains was 49.4％ in E. coli （82/166） and 8.6％ in K. pneumoniae （7/81）. The sensitivity of E. coli to carbapenems was higher than 98.5％. The sensitivity rate of K. pneumoniae to carbapenems was 100％. The sensitivity rate of P. aeruginosa to carbapenems was higher than 90.0％. Among 447 hospitalized BSI patients， CABSI accounted for 49.2％ and HABSI accounted for 50.8％. Distribution of underlying diseases （including diabetes mellitus， malignant tumor， hematological disease， urinary tract infection， liver disease， bitiary tract disease）， invasive operation， the proportion of patients with length of hospital stay＞2 weeks and death proportion were higher in HABSI group than CABSI group （P＜0.05）. CONCLUSIONS： The blood culture pathogens mainly came from infectious diseases department in our hospital. The most common pathogens were Coagulase negative Staphyococcus and E. coli. HABSI occurs more readily in immunocompromised patients and has a poor prognosis. Clinicians should reduce the use of invasive procedures and use appropriate antimicrobial agents for anti-infective treatment.