血培养病原菌的分布及耐药性分析  

Analysis of the distribution and drug resistance of pathogenic bacteria in blood cultures

作　　者：张义永[1] 马筱玲[1] 付广林[1] 高玉录[1] 鲁怀伟[1] 

机构地区：[1]安徽医科大学附属省立医院检验科,合肥市230001

出　　处：《中华实用诊断与治疗杂志》2009年第3期220-222,共3页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的:了解本院血培养病原菌的分布及常见致病菌的耐药特点,为临床用药提供依据。方法:采用Bact/Alert120进行自动血培养,并以Vitek-32微生物分析系统进行细菌鉴定及药敏分析。结果:10 291份临床标本中分离出病原菌651株。其中,革兰阳性菌323株(49.62%),革兰阴性菌265株(40.71%),真菌63株(9.68%)。在革兰阳性球菌中最常见的为血浆凝固酶阴性葡萄球菌,占革兰阳性菌63.78%,占总分离菌31.64%;其次为肠球菌,占革兰阳性菌16.10%,占总分离菌7.99%。革兰阴性菌中最常见的为大肠埃希菌,占18.13%,占革兰阴性菌的44.15%。葡萄球菌中耐甲氧西林凝固酶阴性葡萄球菌和耐甲氧西林金黄色葡萄球菌的分离率分别为83.98%和59.26%,未发现对万古霉素耐药菌株。屎肠球菌对青霉素及氨苄青霉素全部耐药,对庆大霉素的耐药率较高。革兰阴性菌中产超广谱β-内酰胺酶的大肠埃希菌和肺炎克雷伯菌检出率分别为56.78%和40.00%,对亚胺培南、头孢西丁耐药率较低;铜绿假单胞菌除对亚胺培南、头孢他啶、庆大霉素、奈替米星较为敏感外,对其他抗生素均有较高的耐药性。结论:血培养病原菌以条件致病菌为主,且耐药问题严重,及时监测病原菌变化及耐药趋势以指导临床用药至关重要。Objective To investigate the distribution of pathogenic bacteria in the blood culture, and observe the drug resistance of common pathogenic bacteria in our hospital for empirical antimicrobial therapy. Methods The blood cultures Bact/Alert120 system was applied for culture. The species identification and antibiotic resistance tests were performed with the VITEK-32 automicroscan system. Results Among the 10 291 clinical samples, totally 651 strains of pathogenic bacteria were isolated. 49.62% （n=323） were gram-positive cocci, 40.70% （n=265） were gram-negative cocci, and 9.68% （n=63） were fungi. The coagulase negative staphylococcus isolates accounted for 63. 780/oo of all gram-positive isolates and 31. 64% of all isolates. The second was enterococcus isolates accounted for 19.10% of all gram positive isolates and 7.99% of all isolates. E. coli was dominant, accounted for 18.13% of all isolates and 44.15% of all gram negative isolates. About 83.98% of S. aureus and 59.26% of coagulse negative staphy-lococcus were methicillin-resistant. No vancomycin-resistant was found. Staphylococcus was resistant against penicillin and ampicillin, which was higher than gentamycin. The prevalence of extended-spectrum β-lactarnases was 56.78% in E. coli, 40.00% in K. pneumoniae. The resistance rate of staphylococcus was lower than imipenem and cefoxitin. P. aeruginosa was susceptible to imipenem, ceftazidime, gentamycin and netilmicin. The drug resistance of it to other kinds of antibiotics were higher. Conclusion The most pathogenic bacteria isolated from blood specimens are opportunistic antibiotics pathogens, and drug resistance of isolated pathogenic bacteria is a serious problem. Monitoring the change of pathogen and the trends of antimicrobial resistance is very important in guiding the clinical administration.

关 键 词：血培养 病原菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学]