某三甲医院血培养病原菌分布及耐药分析  

Analysis of pathogens distribution and drug resistance from blood culture in a grade 3 A hospital

作　　者：娄小燕[1] 金伟峰[1] 朱莉莉[1] 陈淑子 阳青兰 李萍[1] 林萍[1] 

机构地区：[1]上海市精神卫生中心检验科,200030

出　　处：《国际检验医学杂志》2016年第23期3263-3265,3268,共4页International Journal of Laboratory Medicine

基　　金：吴阶平医学基金会临床科研专项资助基金(320675015232)

摘　　要：目的分析某三甲医院血培养病原菌分布及其耐药性,为临床血流感染(BSI)防控和抗菌药物的合理使用提供依据。方法回顾性分析2014年6月至2016年9月该院住院患者送检的3 241份血培养结果,采用BacT/ALERT 3D和VersaTrek仪器进行血培养,采用VITEK-2Compact和ARIS 2X进行鉴定和药敏试验。结果 3 241份血培养标本中,共分离出病原菌99株,阳性率为3.1%。共分离得到革兰阴性菌42株(42.4%),革兰阳性菌54株(54.5%),真菌3株(3.0%)。分离前3位的革兰阴性菌依次为大肠埃希菌,肺炎克雷伯菌和铜绿假单胞菌;革兰阳性菌依次为:凝固酶阴性葡萄球菌,金黄色葡萄球菌,化脓链球菌。肠杆菌科对亚胺培南、美罗培南、哌拉西林/他唑巴坦、阿米卡星保持100.0%敏感,阳性球菌对万古霉素、利奈唑胺、替考拉宁以及庆大霉素耐药率为0.0%,其余有不同程度耐药。结论大肠埃希菌、凝固酶阴性葡萄球菌和金黄色葡萄球菌是该院血流感染最常见的病原菌,各病原菌对不同抗菌药物耐药性不同,临床需根据药敏试验结果合理选择抗菌药物,减缓耐药菌株的产生。Objective To analyze the distribution and drug resistance of pathogens isolated from blood culture specimens in a grade 3Ahospital so as to provide a basis for the prevention and control of bloodstream infection,and rational antibacterial drugs use.Methods A total of 3 241 blood culture results in our center from June 2014 to September 2016 were analyzed retrospectively.The blood samples were cultivated with the BacT/ALERT 3Dand VersaTrek instruments.The bacterial identification and antibiotic susceptibility tests were conducted with VITEK-2Compact and ARIS 2Xinstruments.Results Among 3 241 blood culture specimens,99 strains of pathogenic bateria were isolated with the positive rate of 3.1%,including 42（42.4%）strains of Gram-negative bacteria,54（54.5%）strains of Gram-positive bacteria and 3（3.0%）strains of fungus.The top three of Gram-negative bacteria were in turn Eescherichia coli,Klebsiella pneumonia and Pseudomonas aeruginosa;the top three of Gram-positive bacteria were in turn coagulase-negative staphylococcus（CNS）,Staphylococcus aureus and streptococcus pyogenes.Enterobacteriaceae remained100.0% sensitivity to imipenem,meropenem,piperacillin/tazobactam and amikacin.The resistance rate of Gram-positive bacterium to vancomycin,linezolid,teicoplanin and gentamycin was 0.0%,the rest had different degrees of drug resistance.Conclusion Eescherichia coli,CNS and Staphylococcus aureus are the most frequent pathogenic bacteria of the blood stream infection in our hospital.Pathogens show different resistance to different kinds of antibacterial agents.Clinic should rationally select the antibacterial agents according to the drug susceptibility test results so as to slow down the generation of drug resistance bacterial strains.

关 键 词：血流感染 病原菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学]