血流感染肠杆菌科细菌临床分布与耐药性研究  

Clinical distribution and drug resistance of Enterobacteriaceae causing bloodstream infections

作　　者：刘周[1] 徐晨[1] 姚杰[1] 方亚平[1] 周强[1] 管世鹤[1] 

机构地区：[1]安徽医科大学第二附属医院检验科,安徽合肥230601

出　　处：《中华医院感染学杂志》2015年第24期5559-5561,共3页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81171662);安徽省卫生厅科学基金资助项目(2010C057);安徽省高等学校省级自然科学研究项目(KJ2012Z156);安徽医科大学校科研基金项目(2012XKJ077)

摘　　要：目的分析血流感染肠杆菌科细菌临床分布特点及其对常用抗菌药物的耐药率,为临床抗感染治疗提供参考依据。方法应用Microscan walkaway-40SI全自动微生物分析仪对2010年1月-2013年12月临床血培养标本分离的肠杆菌科细菌326株进行鉴定,药敏试验采用MIC法及K-B法,数据采用WHONET 5.6软件进行统计分析。结果 2010年1月-2013年12月自临床血培养标本中共分离肠杆菌科细菌326株,主要分布于血液内科、儿科、NICU及ICU,分别占16.9%、11.4%、9.5%及7.4%;主要病原菌包括大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、产气肠杆菌,分别占55.5%、24.8%、4.6%及3.4%,其中产ESBLs大肠埃希菌、肺炎克雷伯菌检出率分别为61.3%、43.2%;肠杆菌科细菌对头孢菌素及喹诺酮类抗菌药物耐药率较高,对碳青霉烯类抗菌药物高度敏感,耐药率仅为0~6.2%,其次为阿米卡星与哌拉西林/他唑巴坦,耐药率分别为3.7%~7.2%、5.5%~20.0%。结论肠杆菌科细菌所致血流感染易发生于免疫系统功能低下且有严重基础疾病人群,病原菌常呈现多药耐药,临床应根据药敏试验结果选择抗菌药物。OBJECTIVE To analyze the clinical distribution and drug resistance of Enterobacteriaceae causing bloodstream infections, so as to provide evidence for clinical anti-infection treatment. METHODS Enterobacteriaceae causing bloodstream infections during Jan. 2010 to Dec. 2013 were identified with Microsean walkaway 40SI auto matic microbial analyzer, antimicrobial susceptibility testing was performed by MIC and disk diffusion, the data were analyzed by WHONET 5.6 software. RESULTS During Jan. 2010 to Dec. 2013, a total of 326 Enterobacteriaceae strains were isolated from clinical blood eulture specimens. The strains were mainly distributed in departments of hematology, pediatrics, NICU and ICU, accounting for 16.9%, 11.4%, 9.5% and 7.4% respectively. The most frequent pathogens were E. coli, K. pneumoniae, E. cloacae and E. aerogenes, accounting for 55.5%, 24.8%, 4.6% and 3.4%, respectively. The detection rates of ESBLs producing E. coli and K. prteumoniae were 61.3% and 43.2 %. Antimicrobial susceptibility testing results showed that strains of Enterobacteriaceae were highly resistant to Cephalosporin and quinolones, but were highly susceptible to earbapenem, with the resistance rate of only 0- 6.2 %, followed by amikacin and piperacillin/tazobactam, with the resistance rates of 3.7 %- 7.2% and 5.5 % - 20.0%. CONCLUSION Bloodstream infections caused by Enterobacteriaceae usually occur in patients with weakened immune systems and serious underlying diseases, the pathogen shows multi-resistance characteris tics. The selection of antibiotics should he based on the antimierobial susceptibility testing results.

关 键 词：血流感染 肠杆菌科细菌 耐药性 

分 类 号：R378.2[医药卫生—病原生物学]