1998年～2006年血流感染病原菌及其耐药性分析  

Distribution and Antibiotic Resistance of Isolates from Bloodstream infections from 1998 to 2006

作　　者：孙自镛[1] 陈静[1] 朱旭慧[1] 张蓓[1] 李丽[1] 杜鹏超[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院检验科,武汉430030

出　　处：《临床内科杂志》2007年第11期736-740,共5页Journal of Clinical Internal Medicine

摘　　要：目的了解血培养中病原菌的分布及其耐药性。方法以商用培养基及仪器培养血液标本；常规方法分离、鉴定细菌；抗菌药物敏感性试验采用纸片扩散法（K-B法）。结果1998年1月-2006年5月血培养分离菌1963株，其中革兰阳性菌1172株（59．7％），革兰阴性菌661株（33．7％），真菌130株（6．6％）。革兰阳性菌以葡萄球菌属为主，金黄色葡萄球菌和凝固酶阴性葡萄球菌（CNS）比例分别为12．4％（145／1172）和64．5％（756／1172）。耐甲氧西林金黄色葡萄球菌（MRSA）的比例为12．4％（18／145）。MRSA和甲氧西林敏感金黄色葡萄球菌（MSSA）对红霉素、克林霉素、庆大霉素、左氧氟沙星、环丙沙星和复方新诺明的耐药率分别为88．9％，52．8％；88．9％，32．5％；68．8％，0％；61．5％，1．9％；55．5％，5％；38．9％，11．2％。未发现万古霉素和替考拉宁耐药的葡萄球菌和肠球菌。革兰阴性菌以肠杆菌科细菌为主（73．4％，485／661），其次为非发酵菌（23．8％，157／661）。大肠埃希菌和肺炎克雷伯菌超广谱B-内酰胺酶（ESBLs）流行率分别为37．3％（90／241）和50．7％（38／75），ESBLs阳性大肠埃希菌和肺炎克雷伯菌对多种抗菌药物耐药率均高于ESBLs阴性细菌。肠杆菌科细菌对碳青酶烯类高度敏感，铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为10．2％和17．9％。检出1株美罗培南耐药的不动杆菌。结论血培养分离菌菌种分布广泛，且耐药现象严重，加强感染检测有助于提高血流感染诊疗水平。Objective To analyze the distribution and antibiotic resistance of isolates from bloodstream infections. Methods All blood culture of patients was performed by BACTECgl20 or BacT/Alert 120 and relevant medium. All strains was isolated and identified by routine methods. Antimicrobial susceptibility testing was conducted on all isolates using Kirby-Bauer methods. Results A total of 1963 strains were isolated from January 1998 to May 2006. Gram-positive and gram-negative isolates accounted for 59. 7% （ n = 1172） and 33.7 % （ n = 661 ）, respectively. Among total strains, 6.6% （ n = 130） were fungi and Staphylococcus spp. isolates accounted for 76.5% （897/1172） of all gram-positive isolates. Of the gram-positive isolates,Staphylococcus aureus and coagulase-negative Staphylococcus accounted for 12.4% （145/1172） and 64.5% （756/1172）, respectively. The strains of methecillin-resistant Staphylococcus aureus （MRSA） accounted for 12.4% （18/145） of Staphylococcus aureus. The resistant rates of MRSA and MSSA to erythromycin, clindamycin, gentamicin, levofloxacin, ciprofloxacin and sulphamethoxazole-trimethoprim were 88.9% ,52.8% ;88.9% ,32.5% ;68.8% ,0% ;61.5%, 1.9% ;55.5% ,5% ;and 38. 9%, 11.2%, respectively. No strains of gram-positive cocci resistant to glycopeptides were detected. Of the gram-negative isolates,Enterobacteriaceae accounted for 73.4% （485/661） and non--fermentative species accounted for 23.8% （ 157/661 ）. ESBLs produced in Escherichia coil and Klebsiella pneumoniae accounted for 37.3% （90/241 ） and 50.7 % （38/75）, respectively. Conclusions The isolates from blood specimen had a wide distribution and the percentage of bacteria resistant to antibiotics was high,emphasizing the fact about the contribution of the detection of blood culture in the diagnosis and therapy of blood stream infections.

关 键 词：血液感染 病原菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学]