败血症患者病原菌分布及耐药性分析  

Distribution and drug resistance of pathogens causing septicemia

作　　者：徐叶进[1] 范顺富[1] 郭玉香[1] 付跃娟[1] 

机构地区：[1]金华市中心医院感染科,浙江金华321000

出　　处：《中华医院感染学杂志》2014年第17期4188-4190,共3页Chinese Journal of Nosocomiology

基　　金：浙江省金华市科技局基金资助项目(2010-03-023)

摘　　要：目的探讨医院败血症病原菌分布及其耐药性特点,以指导临床合理使用抗菌药物。方法对医院2010年6月-2012年6月338例败血症住院患者进行回顾性分析,血液培养采用全自动血培养仪,VITEK-AMS微生物鉴定仪进行病原菌鉴定和体外药敏试验。结果 338例败血症住院患者送检的2 561份血液标本中共分离出病原菌338株,检出阳性率为13.2%,其中革兰阳性菌110株占32.5%;革兰阴性菌216株占63.9%;真菌12株占3.6%;338株病原菌主要分布于ICU、血液科、感染科,分别占22.8%、19.2%和15.7%;检出大肠埃希菌84株占24.9%,其中产ESBLs大肠埃希菌49株占58.3%,检出肺炎克雷伯菌36株占10.7%,其中产ESBLs肺炎克雷伯菌14株占38.9%,检出金黄色葡萄球菌23株占6.8%,其中MRSA 12株占52.2%,检出凝固酶阴性葡萄球菌30株占8.9%,其中MRCNS 26株占86.7%;病原菌对常见抗菌药物的耐药性高,并出现多耐药性;革兰阴性菌对碳青霉烯类抗菌药物最敏感;革兰阳性菌对万古霉素、利奈唑胺最敏感。结论 ICU、血液科、感染科是败血症的高发科室,败血症病原菌以革兰阴性菌为主,病原菌有较高耐药性,故临床医师需及时掌握病原菌分布及耐药性的变化,合理指导抗菌药物使用。OBJECTIVE To explore the distribution and drug resistance of pathogens causing septicemia so as to provide guidance for reasonable clinical use of antibiotics. METHODS A total of 338 patients with septicemia who were hospitalized from Jun 2010 to Jun 2012 were retrospectively reviewed, then the blood culture was performed by using automatic blood culture system, the pathogens were identified by means of VITEK-AMS microorganism identification system, and the in vitro drug susceptibility testing was performed. RESULTS Totally 338 strains of pathogens have been isolated from 2 561 blood specimens that were submitted from the 338 patients with septicemia, and the positive rate of detection was 13.2%. Among the isolated pathogens, there were 110 （32.5%） strains of gram-positive bacteria, 216 （63.9%） strains of gram-negative bacteria, and 12 （3.6%） strains of fungi. Of the 338 strains of pathogens isolated, 22. 8% were isolated from the ICU, 19.2% from the department of hematology, 15.7% from the department of infection control. Totally 84 （24.9 %） strains of Escherichia coli were isolated, among which the ESBLsproducing E. coli accounted for 58. 3% （49 strains ） ; 36 （10.7%） strains of Klebsiella pneumoniae were isolated, among which the ESBLs-producing K. pneumoniae accounted for 38.9% （14 strains ） ; 23 （6.8%） strains of Staphylo-coccus aureus were isolated, among which the MRSA accounted for 52.2% （ 12 strains）, the eoagulase-negative StaphylococcusS. 9%（30 strains ）; among the coagulase-negative Staphylococcus, the MRCNS accounted for 86. 7% （26 strains）. The pathogens were highly resistant to the commonly used antibiotics and showed multidrug-resistance; the gram-negative bacteria were most susceptible to carbapenems; the gram-positive bacteria were most susceptible to vaneomycin and linezolid. CONCLUSION The septicemia is most prevalent in the ICU, department of hematology, and department of infection control. The gram-negative bacteria are the predominant pathogens ca

关 键 词：败血症 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]