5356例血培养病原菌分布及耐药性分析  

作　　者：孙长贵[1] 杨燕[1] 陈坚[1] 林迪[1] 成军[1] 张丽君[1] 

机构地区：[1]杭州解放军第117医院,310013

出　　处：《浙江临床医学》2012年第5期530-532,共3页Zhejiang Clinical Medical Journal

摘　　要：目的了解血培养阳性标本中的病原菌分布和耐药性，以指导临床合理用药。方法患者血标本用BacT／Alert3D全自动血培养仪进行培养，阳性标本分离出的病原菌使用VITEK．32全自动微生物分析系统进行菌株鉴定和药物敏感试验。采用WHONET5．4软件对2009年1月至2011年12月5356例血培养标本所分离的病原菌及药敏结果进行统计分析。结果5356份血培养标本中共分离出病原菌587株，阳性率10．96％。其中革兰阳性球菌233株（39．69％）；革兰阴性杆菌201株（34．24％）；真菌111株（18．91％）；革兰阳性杆菌42株（7．16％）。前10位分离菌种共389株，占总分离菌株66．27％，凝固酶阴性葡萄球菌（120株）居分离菌株首位，其后依次为白色念珠菌（61株）、金黄色葡萄球菌（56株）、大肠埃希菌（47株）、粪肠球菌（23株）、鲍曼不动杆菌（22株）、乙酸钙不动杆菌（17株）、土生拉乌尔菌（16株）、热带念珠菌（14株）和肺炎克雷伯菌（13株）。革兰阳性菌对万古霉素、利奈唑胺敏感性较高，耐药率均为0％。革兰阴性杆菌对碳青霉烯类药物的耐药率低，对其他抗菌药物均存在不同程度耐药，耐药率在12．5％～87．23％之间。白色念珠菌、季也蒙念珠菌和热带念珠菌对两性霉素B、5-氟胞嘧啶、氟康唑和伊曲康唑等耐药率较低（1．64％～13．33％），未检出对伏立康唑耐药株。结论血培养中革兰阳性球菌是最常见分离细菌，其次为革兰阴性杆菌，真菌分离率在增加。大部分菌株对多种抗菌药物耐药，提示临床应予以重视。Objective To investigate the distribution and drug-resistance of pathogens from positive blood culture, so that to provide reference for clinical the rational use of antimicrobial agents. Methods Blood samples were cultured by BacT/ Alert 3D system, identification of isolates from positive blood culture bottles were implemented by V1TEK-32 system as well as the antimicrobial susceptibility testing, the data of the strains isolated from 5356 blood culture specimens from January 2009 to December 2011 were analyzed retrospectively by WHONET5.4 software. Results Of 5356 blood culture specimens, 587 ones were detected to have pathogens, which revealed 10.96% positive rate, including 233 gram-positive cocci （ 39.69% ） , 201 gram-negative bacilli （ 34.24% ） , 111 fimgus （ 18.91% ） and 42 gram-positive bacilli （ 7.16% ） .The top 10 bacteria, altogether 389 strains, accounted for 66.27% of the whole isolates. Coagulase-negative staphylococci （ 120 strains ） stood first on the list, followed by Candida albicans （ 61 strains ） , Staphylococcus aureus （ 56 strains ） , Escherichia coli （ 47 strains ） , Enterococcus faecalis （ 23 strains ） , Acinetobacter baumannii （ 22 strains ） , Acinetobacter calcoaceticus （ 17 strains ） , Raoultella terrigena （ 16 strains ） , Candida tropicalis （ 14 strains ） and Klebsiella pneumoniae （ 13 strains ） . Gram-positive bacteria had high sensitivity tO Vancomycin and Linezolid, with the resistance rate of 0%. Gram-negative bacteria had low resistance rate to carbapenems, while 12.5%-87.23% resistance rate to other antibacterial agents. The resistance rate ofAMB, 5-FC, FCA and ITR etc against Candida albicans, Candida guilliermondii and Candida tropicalis were low （ 1.64%-13.33% ） , and there was no resistant strain to VRC. Conclusion The most common isolates from blood culture are gram-positive cocci, followed by gram-negative bacteria.The pathogenic fungi isolation rates are increasing. Most of the bacteria recovered from blood spec

关 键 词：血培养 病原菌 抗菌药物 耐药性 

分 类 号：R515.3[医药卫生—内科学]