2010-2014年血培养检出病原菌分布与耐药特征  

Distribution and drug resistance of pathogens cultured from blood in 2010-2014

作　　者：邵卫勇[1] 陈淑丹 许玲敏[3] 于小妹[1] 周欢琴[1] 肖震[1] 马晓云[1] 范芳华[1] 

机构地区：[1]浙江医院检验科,浙江杭州310013 [2]浙江出入境检验检疫局国际旅行卫生保健中心,浙江杭州310003 [3]浙江省医学科学院病毒所,浙江杭州310013

出　　处：《中华医院感染学杂志》2015年第21期4838-4840,4863,共4页Chinese Journal of Nosocomiology

基　　金：浙江省自然科学基金资助项目(X207580)

摘　　要：目的回顾性分析医院2010年2月-2014年2月送检血培养阳性分离菌的临床分布以及耐药特征,以提高疾病治愈率。方法采用血培养瓶采样,Bact/Alert 3D全自动血培养仪进行培养,VITEK-2Compact对所有菌株进行鉴定与药敏试验,参照CLSI2013年版判读结果,使用WHONET5.6软件进行统计分析。结果 4年中临床送检6 261份非重复患者血培养标本,分离出661株病原菌,分离率为10.6%,包括革兰阴性菌452株占68.4%、革兰阳性菌190株占28.7%、真菌19株占2.9%;肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、表皮葡萄球菌检出率分别列前4位,总体污染率为4.2%;亚胺培南对革兰阴性菌仍有较好的抗菌活性;葡萄球菌属中未检出对利奈唑胺、喹奴普汀/达福普汀和万古霉素耐药株。结论医院临床血流感染以肺炎克雷伯菌为主,但真菌感染的机会增多,鉴于双份血培养具有提高培养检出率和一定鉴别污染的能力,应提高双瓶双侧血培养送检率。OBJECTIVE To retrospectively analyze the clinical distribution and drug resistant characteristics of the pathogens cultured positive from submitted blood specimens from Feb 2010 to Feb 2014 so as to raise the cure rate.METHODS The blood specimens were collected by using blood culture bottles and were cultured with the use of Bact/Alert 3Dautomatic blood culture system.All the isolated pathogens were identified by means of VITEK-2Compact,the drug susceptibility resting was carried out,the results were interpreted according to CLSI2013,and the statistical analysis was performed by using WHONET5.6software.RESULTS A total of 661 strains of pathogens were isolated from 6 261non-repetitive submitted blood specimens during the 4years,with the isolation rate of 10.6%;there were 452（68.4%）strains of gram-negative bacteria,190（28.7%）strains of gram-positive bacteria,and 19（2.9%）strains of fungi;the isolation rates of Klebsiella pneumoniae,Escherichia coli,Pseudomonas aeruginosa,and Staphylococcus epidermidis ranked the top 4,and the total contamination rate was 4.2%.Imipenem still had favorable antibacterial activity against the gram-negative bacteria;there were no strains of Staphylococcus spp that were found to be resistant to linezolid,quinupristin-dalfopristin,or vancomycin.CONCLUSION The K.pneumoniae is the predominant species of pathogen causing the clinical bloodstream infection,however,the chance to have the fungal infections is increased.Given the double blood culture may raise the isolation rate and has certain capability in identification of contamination,the submission rate of double-side and double-bottle blood culture should be raised.

关 键 词：血流感染 血培养 耐药 

分 类 号：R378[医药卫生—病原生物学]