南阳市5家综合医院住院患者血标本细菌耐药性分析  

Analysis on Antimicrobial Resistance of Blood Specimen in Inpatients from 5 General Hospitals in Nanyang

作　　者：向在永[1] 

机构地区：[1]南阳市第一人民医院药学部,河南南阳473010

出　　处：《中国医院用药评价与分析》2016年第4期527-530,共4页Evaluation and Analysis of Drug-use in Hospitals of China

摘　　要：目的:了解南阳市5家综合医院住院患者临床分离细菌的分布及其对抗菌药物的耐药性,为临床合理使用抗菌药物提供依据。方法:收集2014年1月—2015年9月南阳市市区5家三级综合医院住院患者血培养标本分离的病原菌资料,对常见病原菌的分布特征及其对常用抗菌药物的耐药情况进行分析。结果:25 089份血培养中共分离出病原菌2 968株,阳性率为11.83%,其中革兰阳性球菌占59.80%(1 775/2 968),革兰阴性杆菌占32.78%(973/2 968),真菌占7.41%(220/2 968);凝固酶阴性葡萄球菌居分离菌首位,其次为大肠埃希菌、金黄色葡萄球菌和肺炎克雷伯菌。耐甲氧西林金黄色葡萄球菌、耐甲氧西林凝固酶阴性葡萄球菌的检出率分别为53.02%(158/298)和77.99%(879/1 127);未发现耐万古霉素革兰阳性球菌。产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌的检出率合计为42.04%(280/666);大肠埃希菌、肺炎克雷伯菌对亚胺培南、美罗培南、呋喃妥因、头孢替坦、阿米卡星、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦较敏感。在非发酵革兰阴性杆菌中,铜绿假单胞菌对黏菌素、亚胺培南、美罗培南、头孢吡肟、氨曲南、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦较敏感。结论:血培养分离的病原菌以革兰阳性球菌为主,病原菌分布较广、耐药率较高。临床上应重视血液感染菌株的分布特点,并根据药物敏感性试验结果合理用药,有效控制感染,减少耐药菌株的产生。对细菌耐药性进行定期监测,有助于了解细菌耐药性的变迁,可为临床合理用药提供参考。OBJECTIVE：To investigate the distribution and antimicrobial resistance of the strains isolated from inpatients from 5 general hospitals in Nanyang,so as to provide basis for the rational use of antibiotics in clinic.METHODS：Data of pathogen isolated from blood specimen in inpatients from 5 general hospitals in Nanyang from Jan.2014 to Sept.2015 were collected,and then the distribution characteristics and antimicrobial resistance of common pathogenic bacteria were analyzed.RESULTS：Totally 2 968 strains were isolated from 25 089 blood samples with positive rate of 11.83%.Among the pathogens,gram-positive bacteria accounted for 59.80%（1 775 /2 968）,gramnegative ones accounted for 32.78%（973 /2 968）,and fungi accounted for 7.41%（220 /2 968）.Coagulase negative staphylococci took the first place of isolation,others from more to less were escherichia coli,staphylococcus aureus and klebsiella pneumoniae.The detection rate of methicillin-resistant staphylococcus aureus（MRSA） and methicillinresistant coagulase negative staphylococcus（MRCNS） were 53.02%（158 /298） and 77.99%（879 /1 127）,respectively;and vancomycin-resistant gram-positive cocci was not found.The proportion of producing extended spectrum β-lactamases（ESBL） in escherichia coli and klebsiella pneumoniae was 42.04%（280 /666）.Imipenem,meropenem,nitrofurantoin,cefotetan,amikacin,piperacillin / tazobactam,and cefoperazone / sulbactam were sensitive to escherichia coli and klebsiella pneumoniae.As for the non-fermenting gram-negative bacilli,colistin,imipenem,meropenem,cefepime,aztreonam,piperacillin / tazobactam and cefoperazone / sulbactam were sensitive to pseudomonas aeruginosa.CONCLUSIONS：Gram-positive cocci are the main bacteria in blood culture,the species from which are diversified,and the rate of antimicrobial resistance to some bacteria is high.Clinicians should pay more attention to the distribution characteristics of the clinical isolates of blood stream infections,and use drugs based on rational drug susceptib

关 键 词：血培养 病原菌 药物敏感性试验 细菌耐药性 抗菌药物 合理用药 

分 类 号：R978.1[医药卫生—药品]