2013～2015年血流感染患者的病原体种类及耐药性分析  

Species of pathogenic bacteria and drug resistance in patients with bloodstream infections:a 3-year analysis from 2013 to 2015

作　　者：查翔远[1] 潘晓龙[1] 胡志军[1] 宋有良[1] 王谦[1] 叶珍珠[1] 

机构地区：[1]安徽省铜陵市人民医院感染科,安徽铜陵244000

出　　处：《中国现代医学杂志》2017年第10期117-122,共6页China Journal of Modern Medicine

基　　金：铜陵市卫生和计划生育委员会科研项目(卫科研[2015]5号);安徽省临床医学应用技术项目(No:2008A058)

摘　　要：目的了解血流感染(BSI)的病原体分布及其耐药性,为临床合理应用抗菌药提供依据。方法对2013~2015年铜陵市人民医院BSI患者血培养分离的病原体资料进行统计分析。结果 595株病原体中,革兰阳性菌占50.3%(299/595),革兰阴性菌占48.7%(290/595),真菌占1.0%(6/595)。居前6位的病原体依次为凝固酶阴性葡萄球菌(CNS)(30.6%)、大肠埃希菌(21.5%)、克雷伯菌属(9.1%)、肠球菌属(6.4%)、金黄色葡萄球菌(SA)(5.9%)和不动杆菌属(5.0%)。甲氧西林耐药金黄色葡萄球菌(MRSA)和甲氧西林耐药凝固酶阴性葡萄球菌(MRCNS)分别占SA和CNS的34.3%和76.9%。葡萄球菌属中未发现万古霉素、替考拉宁和利奈唑胺耐药株。粪肠球菌对青霉素G、氨苄西林、万古霉素、替考拉宁和利奈唑胺无耐药;屎肠球菌对万古霉素和替考拉宁耐药率达23.5%,对利奈唑胺无耐药。大肠埃希菌和克雷伯菌属中产ESBLs株分别占50.8%和38.9%;大肠埃希菌对碳青酶烯类耐药率在1.0%以下;克雷伯菌属及肠杆菌属对碳青酶烯类耐药率分别达27.8%和18.2%。不动杆菌属对碳青霉烯类耐药率达70.0%以上。结论 BSI分离的病原体以革兰阳性菌为主,CNS和大肠埃希菌是其最常见的病原体。应重视BSI病原体耐药性监测,加强抗生素的合理使用。Objective To investigate the distribution and antibiotic resistance of clinical isolates from blood culture, and to guide the rational use of antimicrobial agents. Methods Data of pathogens isolated from blood specimens of the patients with bloodstream infections in Tongling People＇s Hospital from 2013 to 2015 were statistically analyzed. Results Of the 595 strains isolated from blood samples, Gram-positive bacteria, Gramnegative bacteria and fungi accounted for 50.3% （299/595）, 48.7% （290/595） and 1.0% （6/595） respectively. The top six pathogens were coagulase-negative Staphflococci （CNS, 30.6%）, E. coIi （21.5%）, KlebsielIa （9.1%）, Enterocoecus spp （6.4%）, S. aureus （SA, 5.9%） and Baumannii spp （5.0%）. Methicillin-resistant （MR） SA and MRCNS accounted for 34.3 % of S. aureus and 76.9 % of CNS, respectively. No strain was found resistant to Vancomycin, Teicoplanin or Linezolid in Staphflococcus spp. No strain was found resistant to Penicillin, Ampicillin, Vancomycin, Teicoplanin or Linezolid in E. faeealis. No strain was found resistant to Linezolid in E. faecium. Vancomycin-resistant and Teicoplanin-resistant E. faecium accounted for 23.5% of the E. faecium isolates. About 50.8% of the E. eoli isolates and 38.9 % of the Klebsiella isolates produced extended-spectrum （5-1actamases （ESBLs）. Less than 1.0% of the E. coli isolates, about 27.8 % of the K1ebsiella isolates and 18.2% of the Enterobaeter spp. isolates, and more than 70.0% of the Baumannii spp isolates were resistant to Carbapenems. Conclusions Gram-positive cocci are the major pathogens causing bloodstream infections in this hospital. CNS and E. coli are the most common pathogens. We should pay more attention to resistance surveillance and rational use of antibiotics.

关 键 词：血流感染 抗菌药物 敏感性 细菌耐药性监测 多重耐药菌 

分 类 号：R378[医药卫生—病原生物学]