住院患者血流感染分离病原体及其耐药性  

Distribution and antimicrobial resistance of pathogens isolated from hospitalized patients with bloodstream infections

作　　者：赵声远[1] 肖淑珍[1] 韩立中[1] 糜琛蓉[1] 倪语星[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院,上海200025

出　　处：《中国感染控制杂志》2014年第5期266-270,共5页Chinese Journal of Infection Control

基　　金：卫生公益性行业科研专项"临床多重耐药菌医院感染防控研究及应用"(201002021)

摘　　要：目的：了解某院住院患者血培养分离病原体种类及耐药情况，为临床合理使用抗菌药物和防控医院获得性血流感染（BSI）提供科学依据。方法对该院2012年1月1日-12月31日住院患者送检的16428份血培养标本进行分离培养、细菌鉴定和药敏试验。结果5546例住院患者送检血培养标本16428份，血培养阳性者384例，病例阳性率为6.92%。检出病原体398株，其中革兰阳性（G＋）菌94株（23.62%），革兰阴性（G-）菌272株（68.34%），真菌32株（8.04%）。61-80岁组患者阳性率（8.26%）最高；送检阳性率居前5位的科室分别是灼伤整形科、中医科、心外监护室、移植病区和创伤外科。G＋球菌对万古霉素、替考拉宁、利奈唑胺保持高敏感率，发现1株耐万古霉素屎肠球菌；G-杆菌中，肠杆菌科细菌对阿米卡星、碳青霉烯类药物敏感率高，其中鲍曼不动杆菌、铜绿假单胞菌对碳青霉烯类药物的耐药率分别为70.97%、35.90%。结论该院BSI病原体以G-菌为主，老年患者血培养阳性率高。医院应尽力提高血培养阳性检出率，并定期对病原体分布和耐药情况进行监测。Objective To investigate the species and drug resistance of pathogens causing bloodstream infections in hospitalized patients,and provide scientific evidence for antimicrobial use and control of healthcare-associated blood-stream infection.Methods From January 1 to December 31,2012,16 428 blood specimens were performed blood culture,pathogens were isolated and performed antimicrobial susceptibility testing.Results Of 16 428 blood speci-mens from 5 546 patients,384 （6.92%）were positive for blood culture,398 pathogenic isolates were detected,of which gram-positive bacteria,gram-negative bacteria,and fungi accounted for 23.62% （n=94）,68.34% （n=272）,and 8.04% （n=32）respectively,positive rate of blood culture were highest in 61-80 age group（8.26%）, the top five departments of positive rate of blood culture were departments of burn,traditional Chinese medicine, cardiac intensive care unit,transplantation and traumatology;gram-positive cocci were highly susceptible to vanco-mycin,teicoplanin and linezolid,one Enterococcus faecium strain was found to be resistant to vancomycin;Among gram-negative bacilli,Enterobacteriaceae were highly susceptible to amikacin and carbapenems;drug resistance rates of Acinetobacterbaumannii and Pseudomonasaeruginosa to carbapenems was 70.97% and 35.90% respective-ly.Conclusion Gram-negative bacteria are the major pathogens causing bloodstream infection,positive rate of blood culture of elderly people is high.It is necessary to conduct regular surveillance on distribution and drug resistance of pathogens.

关 键 词：血流感染 医院感染 血培养 病原体 抗菌药物 抗药性 微生物 合理用药 

分 类 号：R181.32[医药卫生—流行病学]