2013-2015年某院血培养阳性病原菌的分布与耐药监测  

Distribution and antimicrobial resistance surveillance in the positive strains isolated from blood culture in a hospital of Hubei from 2013 to 2015

作　　者：郭静[1] 陈浩俊[1] 冯丽娜[1] 李从荣[1] 

机构地区：[1]武汉大学人民医院检验科,湖北武汉430060

出　　处：《海南医学》2017年第6期931-934,共4页Hainan Medical Journal

基　　金：国家重点临床专科建设项目(编号:财社[2010]305)

摘　　要：目的了解武汉大学人民医院连续三年血培养阳性病原菌的分布和耐药情况,为临床医生合理用药提供参考依据。方法回顾性分析2013-2015年我院血培养分离得到的病原菌,通过全自动微生物鉴定药敏系统BD-Phoenix-100进行鉴定,按照2014年CLSI M100-S24标准判读药敏试验结果。结果三年间血培养共分离出1 468株病原菌,其中革兰氏阳性菌685株(46.7%),革兰氏阴性菌783株(53.3%);血培养病原菌检出率较高的科室有ICU、肾病内科、神经内科等;最常见的革兰氏阳性菌为金黄色葡萄球菌、粪肠球菌和屎肠球菌,在金黄色葡萄球菌中,MRSA的分离率为35.3%,未发现对利奈唑胺、替考拉宁耐药的菌株,对万古霉素亦保持着97.9%的敏感率;最常见的肠杆菌科细菌为大肠埃希菌、肺炎克雷伯菌,其次为阴沟肠杆菌和产气肠杆菌,除了少数肠杆菌科细菌对亚胺培南、美罗培南中介外,其余菌株均对这两种抗生素敏感,对阿米卡星和左氧氟沙星的敏感率亦在85%以上;铜绿假单胞菌对多种常用抗生素均保持较高敏感性,而鲍曼不动杆菌对各项常用抗菌药物耐药率则较高。结论大肠埃希菌和金黄色葡萄球菌仍然是血流感染中的主要病原菌,未发现对利奈唑胺、替考拉宁耐药的金黄色葡萄球菌,但常规剂量使用这两种药物疗效不明显且易产生耐药性;亚胺培南和美罗培南依然是针对肠杆菌科较敏感的抗生素,但已出现部分中介菌株,因此临床上要根据药敏试验结果合理选用抗菌药物,以降低抗菌药物选择压力。Objective To investigate the distribution and drug resistance of pathogens causing bloodstream in-fections in Renmin Hospital of Wuhan University for three consecutive years, and to provide reference for clinicians＇ ra-tional antimicrobial use. Methods Pathogens isolated from blood culture from 2013 to 2015 were analyzed retrospec-tively. All the isolated positive bacteria were identified by automatic bacteria identification and drug susceptibility sys-tems BD-Phoenix-100 and in accordance with the standard of CLSI of 2014 to explain the antimicrobial susceptibility test results. Results A total of 1468 strains, were isolated from blood culture among three years. Gram-positive bacte-ria, Gram-negative bacteria accounted for 46.7% （685/1468）, 53.3% （783/1468）, respectively. Departments which have high pathogen detection rate in blood cultures were ICU, renal medicine, neurology. The top three Gram-positive bacteria were S. aureus, E. faecium and E. faecalis. The prevalence of Methicillin resistant S. aureus （MRSA） was 35.3% in S. aureus. No staphylococcal isolate was found resistant to teicoplanin or linezolid. Sensitive rates of MRSA to vancomycin was 97.9%. E. coli, K. pneumoniae, E. cloacae and E. aerogenes were the most frequently isolated Gram-neg-ative Enterobacteriaceae bacteria, and most strains were sensitive to imipenem or meropenem except few strains. Sensi-tive rates of Enterobacteriaceae to amikacin or levofloxacin were more than 85%. P. aeruginosa isolates were still sus-ceptible to the commonly used antibiotics, but A. baumannii isolates were highly resistant to all the commonly used anti-biotics. Conclusion Our surveillance data indicated that E. coli and S. aureus were still the most common pathogens in blood stream infections. No staphylococcal isolate was found resistant to teicoplanin or linezolid, and if the conventional dose of both drugs to use, efficacy was not obvious and pathogenic bacteria were easy to produce drug resistance. Imipe-nem and meropenem were still the most sen

关 键 词：血流感染 病原菌 临床分布 耐药性 

分 类 号：R446.112[医药卫生—诊断学]