脓毒症的病原菌分布、药敏分析及优选抗菌 药物策略

Distribution of Pathogens, Antimicrobial Susceptibility Analysis and Optimal Antibacterial Drug Strategy in Sepsis

摘要: 目的：为临床医师提供脓毒症的有效抗感染治疗经验。方法：回顾性收集2024年10月~2025年3月重庆市永川区的三家医院的脓毒症病例，对符合排除及纳入标准的608例脓毒症患者的病原菌及药敏结果进行分析。结果：导致脓毒症的主要病原菌是大肠埃希氏菌(27.6%)、肺炎克雷伯菌(13%)、鲍曼不动杆菌(7%)、金黄色葡萄球菌(6%)、铜绿假单胞菌(5.6%)，以格兰氏阴性杆菌为主。大肠埃希氏菌敏感率 > 95%的抗菌药物是阿米卡星、头孢替坦、头孢哌酮钠/舒巴坦、替加环素及多利培南、厄他培南、美罗培南、亚胺培南；肺炎克雷伯菌未出现敏感率 > 95%的抗菌药物，95% > 敏感率 ≥ 90%的抗菌药物是阿米卡星、替加环素及多利培南、厄他培南、美罗培南、亚胺培南；鲍曼不动杆菌未出现敏感率 ≥ 90%的抗菌药物，90% > 敏感率 > 85%的抗菌药物是替加环素；金黄色葡萄球菌敏感率达100%的抗菌药物是庆大霉素、替加环素、万古霉素及喹努普汀/达福普汀；铜绿假单胞菌的敏感率 ≥ 90%的抗菌药物是阿米卡星、妥布霉素、庆大霉素。结论：导致脓毒症的主要病原菌是革氏阴性杆菌，抗感染治疗脓毒症优选抗革兰氏阴性杆菌为主的抗菌药物，推荐经验性优选替加环素、阿米卡星、多利培南、厄他培南、美罗培南、亚胺培南。

Abstract: Objective: To provide a reference for effective anti-infective treatment for clinicians managing sepsis. Methods: We retrospectively collected data on sepsis cases from three hospitals in Yongchuan District, Chongqing, from October 2024 to March 2025. A total of 608 patients who met the inclusion and exclusion criteria were included, and their pathogen distribution and antimicrobial susceptibility were analyzed. Results: The main pathogens causing sepsis were predominantly Gram-negative bacilli, including Escherichia coli (27.6%), Klebsiella pneumoniae (13%), Acinetobacter baumannii (7%), Staphylococcus aureus (6%), and Pseudomonas aeruginosa (5.6%). The antimicrobial agents with a susceptibility rate of >95% for Escherichia coli were amikacin, cefotetan, cefoperazone/sulbactam, tigecycline, and doripenem, ertapenem, meropenem, and imipenem. No antimicrobial agents with a susceptibility rate of ≥95% were found for Klebsiella pneumoniae; agents with a susceptibility rate of 90%~95% included amikacin, tigecycline, doripenem, ertapenem, meropenem, and imipenem. No antimicrobial agents with a susceptibility rate of ≥90% were found for Acinetobacter baumannii; the only agent with a susceptibility rate of 85%~90% was tigecycline. The antimicrobial agents with a 100% susceptibility rate for Staphylococcus aureus were gentamicin, tigecycline, vancomycin, and quinupristin/dalfopristin. The antimicrobial agents with a susceptibility rate of ≥90% for Pseudomonas aeruginosa were amikacin, tobramycin, and gentamicin. Conclusion: The main pathogens causing sepsis are Gram-negative bacilli. Antimicrobial therapy for sepsis should provide coverage against Gram-negative bacilli. Tigecycline, amikacin, doripenem, ertapenem, meropenem, and imipenem are recommended as empirical antimicrobial agents of choice.