败血症病原菌临床分布及耐药性研究  

Clinical Distribution and Drug Resistance of Pathogenic Bacteria in Septicemia

作　　者：陈迎晓[1] 李庆兴[1] 王邦松[1] 张慧芳[1] 朱晓娜[1] 

机构地区：[1]温州医学院附属第一医院感染科,浙江温州325000

出　　处：《中华医院感染学杂志》2008年第12期1786-1789,共4页Chinese Journal of Nosocomiology

摘　　要：目的了解败血症病原菌临床分布及其耐药性的变化,以指导临床合理用药。方法采用全自动血培养仪进行血液培养,用VITEK-AMS微生物鉴定仪进行病原菌鉴定和体外药敏试验,并采用体外扩散确证试验对大肠埃希菌和肺炎克雷伯菌进行超广谱β-内酰胺酶(ESBLs)的检测。结果221株败血症病原菌主要分布于重症监护病房(ICU)、血液科和感染科;分离出大肠埃希菌61株、肺炎克雷伯菌26株,其中产ESBLs菌株分别为24株(39.3%)、7株(26.9%);ESBLs阳性株对多种抗菌药物耐药性明显高于ESBLs阴性株;分离出葡萄球菌属32株,其中耐甲氧西林葡萄球菌(MRS)20株(62.5%);葡萄球菌属产β-内酰胺酶27株(84.4%);病原菌出现多药耐药且耐药水平增高;对革兰阳性菌和革兰阴性菌最敏感的药物分别是万古霉素和亚胺培南。结论ICU、血液科和感染科是败血症的高发科室;败血症病原菌出现多药耐药且耐药水平增高,产ESBLs是革兰阴性菌耐药的主要机制;应重视败血症的防治,常规开展产ESBLs菌株的检测,指导抗菌药物合理应用,延缓耐药株的产生。OBJECTIVE To investigate the distribution and drug resistance of pathogenic bacteria in septicemia in order to provide the reference for clinical antimicrobial agents usage. METHODS The blood samples of inpatients were cultured with blood culture apparatus, VITEK-AMS was used to identify the bacteria and conduct drug resistance test and ESBLs produced by Escherichia coli, and Klebsiella were detected by disc diffusion confirmatory test. RESULTS The 221 strains of pathogens that caused septicemia were mainly distributed in ICU, blood department and infection department. The 61 strains of E. coli were isolated, among which ESBLs were detected and accounted for 3,9.3 % （24）, 26 strains of Klebsiella were isolated, among which ESBLs were detected and accounted for 26.9% （7）, ESBLs strains were more resistant than ESBLs negative strains. Thirty two strains of Staphylococcus were isolated, among which MRS were detected and accounted for 62.5 % （20）. The pathogens showed highly multiple drug-resistance. Vancomycin and imipenem were the highest susceptible for Gram-positive and Gram-negative bacteria, respectively. CONCLUSIONS The pathogens that caused septicemia are mainly distributed in ICU, blood department and infection department. The situation of antibiotic resistance of pathogens is very serious now. Therefore, it is important to prevent the septicemia and to detect enzyme producing strains regularly for reference of reasonable antihiotic use.

关 键 词：败血症 病原菌 耐药性 超广谱Β-内酰胺酶 

分 类 号：R978.1[医药卫生—药品]