321例ICU血培养标本常见病原菌分布及耐药性分析  

ICU blood stream infections and antimicrobial resistance of pathogens

作　　者：臧婉[1] 陈伟[1] 鲁卫平[1] 黎敏[1] 王俊霁[1] 张峰岭[1] 邓少丽[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所检验科,重庆400042

出　　处：《重庆医学》2012年第28期2927-2929,共3页Chongqing medicine

摘　　要：目的监测和分析该院重症监护室近5年来血培养中的病原菌分布和耐药特点,为临床抗感染治疗提供依据。方法回顾性调查分析2006年4月至2011年4月321份血培养及药敏试验结果。结果血培养标本共获病原菌321株,其中革兰阴性杆菌占49.2%,主要以肺炎克雷伯菌、洋葱伯克霍尔德菌、阴沟肠杆菌、鲍曼不动杆菌、大肠埃希菌为主。革兰阳性球菌占42.4%,主要为凝固酶阴性葡萄球菌、金黄色葡萄球菌、肠球菌。真菌占8.4%,以白色假丝酵母菌为主。药敏结果显示,凝固酶阴性葡萄球菌和金黄色葡萄球菌耐甲氧西林分别为94.8%和76.5%,革兰阳性球菌中未发现对万古霉素、替考拉林、利奈唑胺、奎奴普丁/达福普汀耐药的菌株。革兰阴性杆菌对阿米卡星、碳青霉烯类药物保持高度敏感,肺炎克雷伯菌和大肠埃希菌中产ESBLs株分别为77.3%和87.5%。真菌对抗真菌药物敏感率均较高。结论病原菌以革兰阴性杆菌为主,细菌耐药性呈增长趋势,尤其多重耐药革兰阴性杆菌增多,对临床构成严重威胁。Objective To identify the spectrum of pathogens blood culture in the past five years in intensive care unit and their resistance profiles. Methods Pathogenic bacteria isolated from specimens of 321 blood culture cases were identified and drug sus- ceptibility tests were performed. Results Among 321strains of pathogenic bacteria,gram-positive organisms accounted for 42.4% of isolates, while gram-negative for 49.2 % and fungus for 8.4 %. The commonest gram-negative pathogens causing blood infection were Klebsiella pneumoniae, Burkholderia cepacia, enterobacter cloacae, and Acinetobacter baumannii and Eseherichia coli. The com- monest gram-positive organisms were coagulase-negative staphylococcus, Staphylococcus aureus, Enterococcus. Candida albicans, was the main fungi pathogens. Methicillin resistant strains in coagulase-negative staphylococcus（MRCNS） and Staphylococcus au- reus（MRSA） accounted for an average of 94.8% and 76.5% respectively. No Staphylococcus strain was resistant to vancomycin, teicoplanin,linezolid or quinupristin/dalfopristin. Strains of Enterobacteriaceae were still highly susceptible to carbapenems, Among gram-negative isolates,77.3% of Klebsiella pneumoniae and 87.5% Escherichia coli isolates were ESBL producers. Fungus were sensitive to antifungal agents. Conclusion Gram-negative pathogens are the main bacteria in the blood culture. Bacterial resistance is on the rise,especially the incidence of multi-drug resistance strains of gram negative organisms,which has become a major chal- lenge to medical clinics.

关 键 词：培养基 病原菌 抗药性 细菌 

分 类 号：R446.5[医药卫生—诊断学]