血液培养病原菌分布和耐药性变迁  

The distribution of pathogenic bacteria in hemoculture and the diversify of drug resistance

作　　者：冯羡菊[1] 罗予 曾利[1] 徐岷[1] 

机构地区：[1]郑州大学第一附属医院检验科,河南郑州450052 [2]河南省医药科学研究院,河南郑州450052

出　　处：《中国微生态学杂志》2010年第1期52-55,共4页Chinese Journal of Microecology

基　　金：河南省医学科技攻关项目(200703033)

摘　　要：目的了解血培养分离病原菌的分布及耐药性变迁。方法用WHONET5．4软件对血培养结果进行回顾性统计分析。结果2006～2008年血培养标本中分离阳性率分别为9．4％、10．3％和11．6％；革兰阳性球菌3年分离率在逐年增加：分别为40．9％、48．7％和53．2％，主要为金黄色葡萄球菌、表皮葡萄球菌和粪肠球菌；革兰阴性杆菌分离率分别为55．4％、50．7％和41．2％，主要为大肠埃希菌、铜绿假单胞菌；嗜麦芽窄食单胞菌和布氏杆菌的分离率也呈逐年增高趋势。葡萄球菌中MRSA3年的检出率是57．9％、61．5％和76．2％；MRSE的检出率是76．9％、78．6％和78．70％；大肠埃希菌ESBL的检出率分别是47．2％、61．3％和52．8％，肺炎克雷伯菌ESBL的检出率是46．2％、45．5％和41．2％；耐药性分析显示糖肽类或曙唑脘酮抗菌药物对革兰阳性球菌敏感率最高，碳氢霉烯类及阿米卡星对肠杆菌科细菌有较好的抗菌活性；多重耐药和泛耐药的铜绿假单胞菌、鲍曼不动杆菌对多粘菌素、美罗培南敏感性较好。结论2006—2008年血培养标本中革兰阳性球菌的分离率和葡萄球菌中bIRSA的检出率有逐年增加趋势：应加强监测，指导临床抗菌药物合理使用。Objective To understand the distribution of pathogenic bacteria isolated from hemoculture and the diversify of drug resistance. Method A retrospective statistical analysis was used on the hemoculture results with WHONET 5.4 software. Result The positive rates of hemoculture isolated from 2006 to 2008 were 9.4%, 10.3% and 11.6% ,respectively. The isolation rate of Gram-positive coccus had increased year by year （40.9%, 48.7% and 53.2% ） with Staphylococcus aureus, Staphylococcus epidermidis and Enterococcusfaecalis being predominant; The isolation rates of Gramnegative bacilli were 55.4%, 50. 7% and 41.2%, respectively, of which Escherichia coli and Pseudomonas aeruginosa were predominant;The isolation rates of maltophilia S. m. and brucellosis were also in a trend of rising up year by year. For Staphylococcus, the detection rate of MRSA were 57.9%, 61.5 % and 76.2%, respectively;the detection rate of MRSE were 76.9% ,78.6% and 78.70% ,respectively; the detection rate of E. cob ESBL was 47.2% ,61.3% and 52.8% ,respectively, and the detection rate of Klebsiella pneumoniae ESBL were 46.2% ,45.5% and 41.2%, respectively. Resistance analysis showed that Glycopeptides or TMP-Wan had the highest sensitive rate to Gram-positive coccus;Hydrocarbon and vi- nyl sp Amikacin had a better antibacterial activity against Enterobacteriaceae bacteria. As to the multi-drug resistant and pan-resistant Pseudomonas aeruginosa and Baumanii, Polymyxin and Meropenem had a better sensitive rate. Conclusion The isolation rate of Gram-positive coccus and the detection rate of MRSA in hemoculture samples from 2006 to 2008 has increased year by year. Strengthening surveillance should be taken in order for reasonable clinical use of antibacterials.

关 键 词：血培养 病原菌 多重耐药性 变迁 

分 类 号：R378[医药卫生—病原生物学]