医院三年血流感染病原菌分布特征及耐药性分析  

The Distribution and Drug Resistance of Pathogens Causing Nosoeomia Bloodstream Infections in Three Consecutive Years

作　　者：李军[1] 殷和[1] 姚顺青[1] 王琼[1] 

机构地区：[1]解放军第四医院,青海西宁810007

出　　处：《检验医学与临床》2016年第A02期38-41,共4页Laboratory Medicine and Clinic

摘　　要：目的回顾性分析本院3年血培养阳性检出的病原菌分布特征及抗菌药物耐药情况，为血流感染患者的诊断和治疗提供依据。方法2013年1月至2015年12月本院住院患者无菌抽取的血液标本进行培养，对血培养阳性报警后分离培养的纯培养菌落，采用VITEK—Compact2微生物测定系统进行鉴定及药敏试验。结果连续3年共分离出首次非重复病原菌381株，检出率为9．6％，革兰阴性杆菌占60．4％高于革兰阳性球菌，病原菌较多依次为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、凝固酶阴性葡萄球菌，年龄分布主要集中在。-1岁和60-91岁患者中，科室分布主要在儿科、ICU、血液净化科、肿瘤科。药敏结果显示：大肠埃希菌和肺炎克雷伯菌产ESBLS检出率分别为55．2％、33．8％，对头孢西丁、阿米卡星、哌拉西林／他唑巴坦敏感性强，可作为经验用药。葡萄球菌中MRSA检出率为30．0％，MRSCN检出率为52．5％，四环素、米诺环素、莫西沙星、利福平敏感性强，青霉素、大环内酯类抗菌药物对葡萄球菌的耐药率高，万古霉素、利奈唑胺可作为治疗葡萄球菌引起血流感染重症患者的首选用药。结论血流感染病原菌种类多，耐药情况复杂，临床医生应提高对血液及导管的送检率，实验室应重视血流感染病原菌及耐药性监测，尽早为临床提供及时准确的药敏结果，临床应根据药敏结果合理选择抗菌药物，有效控制血流感染耐药菌的产生和传播。Objective To analyze the distribution and drug resistance of pathogens causing nosocomia bloodstream infections in our hospital for three consecutive years retrospectively, and provide a basis for the diagnosis and treatment of bloodstream Infections. Methods Blood samples of inpatient in our hospital from Jan. 2013 to Dec. 2015 were cultured, pathogens were isolated from positive alarm blood culture bottles,pathogens identification and drug susceptibility test were performed by VITEK-Compact2 bac-terium measurement system. Results 381 strains of pathogens were isolated,the detection rate was 9.6%,gram-negative bacilli ac- counted for 60.4% and the detection rate of gram-negative bacilli was higher than that of gram-positive cocci. The top four patho-gens were Escherichia coli,Klebsiella pneumoniae,Staphylococcus aureus and Coagulase-negative staphylococci. The age of patients mainly concentrated in the 0-1 and 60-91 years old. Pathogens mainly distributed in Pediatrics,ICU, Blood purification division,Oncology. The detected rates of E. coli and K. pneumoniae producing ESBLs were 55.2% and 33.8% ,The drug susceptibility of E. coli and K. pneumoniae producing ESBLs to Cefoxitin,Amikacin,Piperacillin/tazobactam were strong and these drugs could be used as experience. The detected rates of MRSA and MRSCN were 30.0% and 52.5%. The drug susceptibility of MRSA and MRSCN to Tetracycline, Minocycline,Moxifloxacin and Rifampicin were strong,and The drug resistance of MRSA and MRSCN to Penicillins and Macrolides were high,Vancomycin and Linezotid can be used as the first choice for the therapy in patients with severe blood-stream infection caused by Staphylococcus. Conclusion Pathogens causing nosocomia bloodstream infections were variety and the drug resistance were complex. Clinicians should raise the submission rate of blood and catheter. Laboratories should pay attention to the monitoring of pathogens and drug resistance. Laboratories should provide timely and accurate drug susceptibility results for Cli- nicians as so

关 键 词：血流感染 血培养 病原菌 耐药性 

分 类 号：R181.34[医药卫生—流行病学]