杭州地区血流感染患者的病原学及耐药分析  

Etiology and Resistance in Bloodstream Infections in Hangzhou Area

作　　者：王淑颖[1] 黄美先[1] 董晓勤[1] 吴旻[1] 李伟[1] 

机构地区：[1]杭州市第一人民医院感染科,浙江杭州310006

出　　处：《中华医院感染学杂志》2010年第24期4005-4007,共3页Chinese Journal of Nosocomiology

基　　金：杭州市医药卫生科技计划项目(2007A002)

摘　　要：目的探讨杭州地区近5年血流感染患者的病原学和常见致病菌的药敏特点。方法对2004-2008年入住杭州市第一人民医院患者的血培养阳性病例,参照美国CDC 1996年医院感染诊断标准中血流感染的诊断标准以确诊血流感染,药敏试验采用K-B法,对其病原菌的分布特点及药敏情况进行统计分析。结果确诊为血流感染者共397例,获病原菌405株,其中革兰阳性菌为38.5%,革兰阴性菌55.8%,真菌5.7%;以凝固酶阴性葡萄球菌(CNS)占首位,为22.7%,其次为大肠埃希菌13.8%;CNS中耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)占70.7%,耐甲氧西林金黄色葡萄球菌(MRSA)占金黄色葡萄球菌的29.4%,未发现耐万古霉素葡萄球菌;大肠埃希菌中产超广谱β-内酰胺酶(ESBLs)者占48.2%;除铜绿假单胞菌中约33.3%耐亚胺培南/西司他丁外,大肠埃希菌、克雷伯菌属对亚胺培南/西司他丁均敏感,三者对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦亦有较高的敏感率,对磺胺甲噁唑/甲氧苄啶、头孢噻肟、氨苄西林/舒巴坦耐药率高。结论杭州地区血流感染的病原菌以革兰阴性菌占优势,CNS居首位;革兰阴性菌耐药情况不容乐观,及时监测病原菌变化及药敏、耐药趋势对指导临床用药至关重要。OBJECTIVE To determine the bacterial distribution and resistance of bloodstream infections in Hangzhou area.METHODS Records of positive blood culture from 2004 to 2008 in Hangzhou area were examined.According to the CDC definition of bloodstream infection,the bloodstream infections were diagnosed.The bacterial isolates were tested by K-B susceptibility,the outcome of distribution features and antibiotic sensitivity of isolates were analyzed.RESULTS A total of 397 episodes were diagnosed and 405 pathogenic isolates were collected.Gram-positive strains,Gram-negative strains and fungi accounted for 38.5%,55.8% and 5.7%,respectively.The commonest pathogens causing bloodstream infections were coagulase-negative staphylococcus（CNS）（22.7%）,followed by Escherichia coli（13.8%）.The susceptibility tests in vitro showed that 70.7% and 29.4% of S.aureus and CNS were meticillin-resistant.No Staphylococcus strain was resistant to vancomycin.The ESBLs positive rate of E.coli was 48.2%.The resistant rate of Pseudomonas aeruginosa to imipenem was 33.3%,while none of E.coli and Klebsiella were resistant to imipenem.All of the three were high susceptible to piperacillin/tazobactam and cefoperazone/sulbactam,but their resistant rates to SXT,cefotaxime and ampicillin/sulbactam were also high.CONCLUSION Gram-negative bacteria are the predominant pathogens and CNS are the most common pathogens to cause bloodstream infection in Hangzhou area.Drug resistance of Gram-negative bacteria is serious.Monitoring the change of pathogen and the trends of antimicrobial resistance is important in guiding clinical drug application.

关 键 词：败血病 病原菌分布 耐药性 抗菌药物 

分 类 号：R378[医药卫生—病原生物学]