血培养病原菌分布及耐药性分析  

Drug resistance and distribution of pathogens isolated from blood culture

作　　者：陈利涛 王晶莹 付雅捷[2] 

机构地区：[1]湖州市安吉第三人民医院检验科,浙江湖州313301 [2]浙江大学医学院附属第一医院检验科,浙江杭州310009

出　　处：《中华医院感染学杂志》2013年第14期3521-3523,共3页Chinese Journal of Nosocomiology

基　　金：浙江省自然科学基金(Y207477)

摘　　要：目的了解浙江北部山区某医院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。方法采用全自动血培养仪Bact/Alert120及专用血培养瓶培养细菌,阳性瓶转种血平板,细菌鉴定采用VITEK-2Compact全自动细菌分析仪,药敏试验采用K-B法,按CLIS 2009年标准判定结果;采用WHONET 5.4软件对2009年1月-2012年10月7941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 7941份血培养标本共检出病原菌588株,阳性率为7.40%,其中革兰阳性菌376株占64.0%,革兰阴性菌164株占27.9%,真菌22株占3.7%,排名前4位病原菌依次为凝固酶阴性葡萄球菌、肺炎克雷伯菌、金黄色葡萄球菌、大肠埃希菌,分别占50.7%、9.9%、9.5%、8.5%;凝固酶阴性葡萄球菌、金黄色葡萄球菌、粪肠球菌除对万古霉素、利奈唑胺100.0%敏感外,对其他抗菌药物均产生了一定的耐药性,其中MRSA占57.1%,MRCNS占41.6%;大肠埃希菌、肺炎克雷伯菌除对其中亚胺培南、美罗培南、阿米卡星敏感外,对其他抗菌药物均产生了较严重的耐药性,白色假丝酵母菌、热带假丝酵母菌除1株白色假丝酵母菌对两性霉素B耐药外,其余菌株对两性霉素B、氟胞嘧啶、氟康唑、伏立康唑和伊曲康唑等均敏感。结论血液标本病原菌检出率相对较低,以革兰阳性菌为主,凝固酶阴性葡萄球菌所占比例高,抗菌药物耐药率较高;了解血流感染病原菌的分布和耐药性,对减少医院感染、指导临床合理使用抗菌药物有重要意义。OBJECTIVE To investigate the distribution and drug resistance of pathogens isolated from positive blood culture in a hospital of the northern Zhejiang so as to provide evidence for rational use of antibiotics in clinic.METHODS The blood samples were cultured by Bact/Alert120 system,the positive samples were inoculated into blood agar,microorganisms were identified by VITEK-2 Compact,then the drug susceptibility testing was performed by using the K-B method,and the result was determined according to CLIS 2009standard;WHONET 5.4 software was used to analyze the data.RESULTS Of totally 7941 blood culture specimens,there were 588 strains of pathogens isolated with the positive rate of 7.40%,including 376（64.0%）strains of gram-positive bacteria,164（27.9%）strains of gram-negative bacteria,and 22（3.7%）strains of fungi;the coagulase-negative Staphylococcus（CNS）,Klebsiella pneumoniae,Staphylococcus aureus,and Escherichia coli ranked the top four species of pathogens,accounting for 50.7%,9.9%,9.5%,and 8.5%,respectively.The CNS,S.aureus,and Enterococcus faecalis have produced certain drug resistance to all the antibiotics except vancomycin and linezolid with the drug susceptibility rate of 100.0%,the MRSA strains accounted for 57.15%,the MRCNS accounted for 41.6%;the E.coli and K.pneumoniae were highly resistant to all the antibiotics except imipenem,meropenem,and amikacin;all the Candida albicans and Candida tropicalis were sensitive to amphotericin B,5-fluorocytosine,voriconazole and itraconazole except one strain of C.albicans resistant to amphotericin B.CONCLUSION The detection rate of the pathogens isolated from blood culture is relatively low,the gram-positive bacteria are predominant,the CNS strains occupy a larger proportion,the drug resistance rate is relatively high.It is of great significance to reduce the incidence of nosocomial infections and guide the reasonable use of antibiotics through understanding the distribution and drug resistance of the pathogens causing bloodstream infections.

关 键 词：血培养 病原菌 抗菌药物 耐药性 

分 类 号：R378[医药卫生—病原生物学]