2014-2015年四川省中医院血培养病原菌分布及耐药性分析  

Distribution and drug resistance of pathogens isolated from blood culture,2014-2015

作　　者：赵茂吉 辛力华[2] 向瑶[1] 杨朝国[1] 

机构地区：[1]成都中医药大学医学技术学院,四川成都611137 [2]四川省中医院检验科,四川成都610032

出　　处：《现代预防医学》2017年第5期894-897,共4页Modern Preventive Medicine

摘　　要：目的分析四川省中医院血培养阳性病原菌分布及耐药性特点,为临床诊断和制定治疗方案提供依据。方法对本院2014-2015年住院病人共6 271份血标本采用ac T/Alert3D 60/120全自动血培养仪进行培养,阳性者用VITEK-2 Compact细菌分析鉴定和药敏试验系统进行细菌鉴定及药敏实验。结果 2014年和2015年送检血标本分别为2 808份和3 463份,病原菌检出率分别为10.90%和9.88%;革兰阴性菌所占比例分别为61.43%和56.30%,前3位均为大肠埃希菌、肺炎克雷伯菌和鲍曼不动杆菌。大肠埃希菌对氨苄西林的耐药率持续偏高(≥86.0%);肺炎克雷伯菌对阿莫西林/克拉维酸及喹诺酮类的耐药率分别从37.50%、18.75%上升至81.25%、50.00%;鲍曼不动杆菌对头孢曲松和氨曲南的耐药率达100.00%。革兰阳性菌中,以凝固酶阴性葡萄球菌、金黄色葡萄球菌和屎肠球菌为主;表皮葡萄球菌对青霉素和苯唑西林的耐药率达100.00%;金黄色葡萄球菌中,MARSA检出率从22.22%上升到34.78%;表皮葡萄球菌和金黄色葡萄球菌均无呋喃妥因、替加环素、万古霉素和利奈唑胺耐药菌株。结论血流感染病原菌主要为革兰阴性细菌;病原菌对常用抗菌药物均有不同程度的耐药,临床应加强细菌耐药性监测,临床医师应根据不同细菌合理选择抗菌药物并严格遵守抗菌素使用指南。Objective To analyze the distribution and drug resistance of the pathogens isolated from blood culture to provide guidance for the clinical diagnosis and treatment. Methods There were 6 271 blood samples in 2014 and 2015 which were cultured by act/Alert3 D 60/120 automated blood culture system. The identification of strains and the drug susceptibility testing were performed by the VITEK-2 Compact system. Results In 2014 and 2015,there were 2808 samples and 3 463 samples.The positive rate of the blood culture were 10. 90% and 9. 88%,respectively,and Gram-negative bacteria accounted for 61.43% and 56. 30%,respectively,and the most common bacteria of them were Escherichia coli,Klebsiella pneumoniae and Acinetobacter baumannii. Escherichia coli strains showed high resistance rates to ampicillin（ over 86. 00%）. The drug resistance rates of Klebsiella pneumoniae toward amoxicillin/clavulanic acid and quinolone increased from 37. 5%,18. 8% to80. 0%,50. 0%,respectively. The resistance rates of Acinetobacter baumannii to ceftriaxone and aztreonam were 100. 00%.Gram-positive bacteria mostly consists of coagulase negative Staphylococcus,Staphylococcus aureus and Enterococcus faecium.The resistant rate of Staphylococcus epidermidis to penicillin and oxacillin was 100. 00%. The positive rates of methicillin-resistant staphylococcus aureus（ MRSA） are 22. 2% and 34. 8% respectively,and no strains were found resistant to nitrofurantoin,tigecycline,vancomycin and linezolid. Conclusion The main pathogens of bloodstream infections are Gram-negative bacteria. These bacteria have different degrees of resistance to commonly used antimicrobial agents,and the clinician should be reasonable to choose antimicrobial agents according to different bacteria.

关 键 词：血培养 病原菌 耐药 

分 类 号：R117[医药卫生—公共卫生与预防医学]