某三级医院2012—2015年血培养病原菌分布及其耐药性  

Distribution and antimicrobial resistance of pathogens in blood cultures in a tertiary hospital from 2012 to 2015

作　　者：陈斌泽 张媛媛[1] 薛荣利[1] 冯强生[1] 哈小琴[1] 彭俊华[1] 

机构地区：[1]中国人民解放军兰州军区兰州总医院,甘肃兰州730050

出　　处：《中国感染控制杂志》2016年第3期164-167,共4页Chinese Journal of Infection Control

基　　金：甘肃省省青年科技基金计划项目(145RJYA291)

摘　　要：目的调查某三级医院血流感染主要病原菌分布及其对抗菌药物的耐药情况,以指导临床合理使用抗菌药物。方法对该院2012年1月—2015年1月怀疑血流感染患者送检的血标本进行培养、鉴定及药敏试验,统计主要病原菌及其药敏结果。结果 19 326份血培养标本共检出病原菌1 658株,分离率为8.58%,其中革兰阴性杆菌占58.57%(971株),主要以大肠埃希菌(32.75%)为主;革兰阳性球菌占39.38%(653株),主要以凝固酶阴性葡萄球菌(CNS,16.34%)为主;真菌占2.05%(34株),以白假丝酵母菌多见。分离病原菌主要分布于血液科、消化内科、心血管外科。大肠埃希菌和肺炎克雷伯菌产ESBLs菌株检出率分别为56.35%和36.14%,但对头孢哌酮/舒巴坦以及碳青霉烯类抗生素高度敏感(耐药率<3%)。革兰阳性球菌中耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)和耐甲氧西林金黄色葡萄球菌(MRSA)所占比率分别为78.60%和32.28%,但对万古霉素、利奈唑胺极敏感(耐药率<1%)。结论该院血流感染病原菌以大肠埃希菌和CNS为主,且耐药率相对较高;定时分析总结血流感染病原菌分布和耐药情况,有助于多重耐药菌感染的防控。Objective To investigate the distribution and antimicrobial resistance of major pathogens causing bloodstream infection in a tertiary hospital,so as to guide the clinical rational use of antimicrobial agents.Methods Blood specimens from patients with suspected bloodstream infection in this hospital between January 2012 and January2015 were cultured,identified and performed antimicrobial susceptibility testing,the major pathogens and antimicrobial susceptibility testing results were analyzed statistically.Results A total of 1 658 strains of pathogens were isolated from19 326 blood culture specimens,isolation rate was 8.58%,in which gram-negative bacilli,gram-positive cocci,and fungi accounted for 58.57%（n=971）,39.38%（n=653）,and 2.05%（n=34）respectively,the major gram-negative bacillus,gram-positive coccus,and fungus were Escherichia coli,coagulase-negative staphylococci（CNS）,and Candida albicans respectively.The isolated pathogens mainly distributed in departments of hematology,gastroenterology,and cardiovascular surgery.Detection rates of extended-spectrumβ-lactamases（ESBLs）-producing Escherichia coli and Klebsiella pneumoniae were 56.35%and36.14%respectively,but were highly sensitive to cefoperazone/sulbactam and carbapenems（resistance rates3%）.The percentage of methicillin-resistant coagulase-negative staphylococcus（MRCNS）and methicillin-resistant Staphylococcus aureus（MRSA） were78.60% and 32.28%respectively,but were highly sensitive to vancomycin and linezolid（resistance rates1%）.Conclusion Escherichia coli and CNS are predominant pathogens causing bloodstream infection in this hospital,antimicrobial resistance rates are high;regular analysis on distribution and antimicrobial resistance of pathogens causing bloodstream infection is helpful for the prevention and control of infection caused by multidrug-resistant organisms.

关 键 词：血流感染 血培养 病原菌 种类分布 抗药性 微生物 耐药性 

分 类 号：R181.32[医药卫生—流行病学]