【摘要】  目的   分析T2DM合并血流感染的病原菌分布及其药敏特征，为临床早期诊断及选用抗菌药物提供依据。 方法   回顾性分析2009年1月至2014年12月66例T2DM合并血流感染病例的临床资料，并进行比较。 结果   入选病例共培养分离出病原菌66株，其中，革兰氏阴性菌47株（71.2%）、革兰氏阳性菌19株（28.8%）；革兰氏阴性菌以大肠埃希菌（19株）和肺炎克雷伯菌（16株）为主，产超广谱β内酰胺酶（ESBLs）菌检出率为29.8%；感染部位以呼吸道（23例）、泌尿道（17例）及胆道（11例）多见；多数革兰氏阳性菌属对青霉素及氨苄西林耐药率高，对万古霉素和替考拉宁敏感性高；大肠埃希菌及肺炎克雷伯菌对氨苄西林耐药率分别为68.4%及100%，对亚胺培南和美罗培南敏感性为100%。  结论   T2DM患者合并血流感染病原菌以革兰氏阴性菌多见，主要为大肠埃希菌及肺炎克雷伯菌，临床应结合血培养合理选择抗菌药物。

【关键词】  糖尿病，2型；血流感染；病原菌；耐药性

 Analysis of pathogens distribution and drug resistance in type 2 diabetic patients complicated with bloodstream infections

【Abstract】 Objective  To study the pathogens distribution and antimicrobial resistance in type 2 diabe-tic (T2DM) patients complicated with bloodstream infections, and to provide the basis of early diagnosis and rational use of antibiotics. s  Methods  66 T2DM patients complicated with bloodstream infections from January 2009 to December 2014 were retrospectively reviewed.  Results  A total of 66 clinical isolates were collected from the blood samples, of which gram negative organisms and gram positive organisms accounted for 71.2% and 28.8%, respectively. Among 47 strains of gram negative organisms, in which 14 (29.8%) strains were ESBLs-pro-ducing isolates, the main isolates were Escheriehia coli (19 strains) and Klebsiella pneumoniae(16 strains). The top three primary infection sites were respiratory tract (23 cases), urinary tract (17 cases) and biliary tract (11 cases). Most of gram positive organisms were high resistant to penicillin and ampicillin while sensi-tive to vancomycin and teicoplanin. The resistance rates of Escheriehia coli and Klebsiella pneumoniae to ampi-cillin were 68.4% and 100%, respectively. No imipenem or meropenem resistant strains of Escheriehia coli and Klebsiella pneumoniae were found.  Conclusion  Gram negative organisms were the main pathogens in T2DM patients complicated with bloodstream infections, especially Escheriehia coli and Klebsiella pneumoniae.  Blood culture and drug sensitive test should be considered before clinical use of antibiotics.

 【Key words】Diabetes mellitus，type 2 ；Bloodstream infection；Pathogens；Drug resistance