血培养及药敏试验后抗菌药选择合理性分析  

Analysis on rationality of antibiotics choice after blood culture and drug sensitivity tests

作　　者：姜云霞[1] 金柔男[1] 王彬[1] 马炜棋[1] 战旗[1] 

机构地区：[1]第二军医大学东方肝胆外科医院药材科,上海200438

出　　处：《药学实践杂志》2012年第2期128-130,145,共4页Journal of Pharmaceutical Practice

摘　　要：目的分析我院住院患者血培养中分离出的病原菌分布及耐药情况,以期指导合理应用抗菌药。方法回顾性分析2009年10月至2010年10月230例住院患者血培养结果。结果共检出病原菌63株。革兰阴性菌、革兰阳性菌、真菌检出率分别为80.9%、17.51%、1.59%。主要病原菌为大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、铜绿假单胞菌,其检出率分别为20.63%、12.7%、9.52%、9.52%。粪肠球菌、表皮葡萄球菌、屎肠球菌的检出率分为9.52%、1.59%、1.59%,未发现对万古霉素耐药的葡萄球菌。大肠埃希菌及肺炎克雷伯菌产超广谱β-内酰胺酶检出率分别为6.34%、1.59%。革兰阴性菌对碳青霉烯类、阿米卡星、哌啦西林/他唑巴坦敏感性均在84%以上。结论治疗严重的革兰阳性菌引起的血液感染可首选万古霉素等糖肽类抗菌药、治疗革兰阴性菌引起的血液感染可首选阿米卡星、β-内酰胺类/β-内酰胺酶抑制剂复方及碳青霉烯类抗菌药。Objective To analysis the distribution and drug resistance of pathogens isolated from blood cultures in hospitalized patients in order to guide the rational application of antibiotics agents.Methods 230 cases of blood culture results in hospitalized patients during 2009 October to 2010 October were retrospectively analyzed.Results 63 strains of pathogenic bacteria were checked out.The detection rate gram-negative bacteria,gram-positive bacteria was 80.9%,17.51%,1.59% respectively.Main pathogenic bacteria were Escherichia coli,Klebsiella spp,Enterobacter,Pseudomonas aeruginosa,with detection rate of 20.63%,12.7%,9.52%,9.52% respectively.The detection rate of E.faecalis,Staphylococcus epidermidis,and E.faecium were 9.52%,1.59%,1.59%.Detection rate of Escherichia coli and Klebsiella spp induced ESBL was 6.34% and 1.59%.The susceptibility of gram-negative bacteria to carbapenem,amikacin,piperacillin/tazobatam were above 84%.Conclusion Glycopeptide antibiotics such as vancomycin were the first choice to cure serious blood infection caused by gram-positive bacterial.Amikacin,β-lactam/β-actamase inhibitors compound,carbapenem were the first choice to cure serious blood infection caused by gram-negative bacterial.

关 键 词：血培养 药敏试验 抗菌药物 选择 

分 类 号：R978.1[医药卫生—药品]