引起血流感染的革兰阴性菌阳性报警时间及流行病学特征分析  

Analysis of positive alarm time and epidemiological characteristics of gram-negative bacteria causing bloodstream infection

作　　者：叶丽艳[1] 沈跃云[1] 李丰田[1] 张永轻[1] 马艳宁[1] 杨继勇[1] 罗燕萍[1] 

机构地区：[1]解放军总医院微生物科,北京100853

出　　处：《中华医院感染学杂志》2017年第11期2445-2448,共4页Chinese Journal of Nosocomiology

基　　金：军队"十二五"基金资助项目(AWS11C001)

摘　　要：目的了解引起血流感染的革兰阴性菌的分布、耐药性及报警时间等特征,利于临床及时开展有效的抗感染治疗。方法采用全自动血培养仪及自动鉴定药敏系统对2012年1月-2016年9月血培养分离的革兰阴性菌进行鉴定及药敏试验,并对阳性报警时间及流行病学特征进行分析。结果 2012年1月-2016年9月共分离出血流感染革兰阴性菌2 488株,以大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌、铜绿假单胞菌为主,分别占39.51%、19.69%、9.65%、8.24%;大肠埃希菌对亚胺培南和美罗培南的敏感率均为99.59%,对环丙沙星、左氧氟沙星的耐药率较高,均>60.00%;肺炎克雷伯菌对亚胺培南和美罗培南的耐药率分别为16.53%和13.27%;除磺胺甲噁唑/甲氧苄啶(40.83%)外,鲍氏不动杆菌对其他抗菌药物的敏感率均<30.00%;平均阳性报警时间最短的是阴沟肠杆菌(0.59d),其次是大肠埃希菌、产气肠杆菌、鲍氏不动杆菌、肺炎克雷伯菌;在0.5d内阳性报警达到40.00%以上的有大肠埃希菌、阴沟肠杆菌、产气肠杆菌、肺炎克雷伯菌,而非发酵菌中的铜绿假单胞菌、嗜麦芽寡养单胞菌、洋葱伯克霍尔德菌在0.5d内阳性报警不到10.00%;除洋葱伯克霍尔德菌(30.77%)外,在1d内阳性报警均可以达到75%以上;不同菌种在0.5d,1.0d和2.5d内的阳性报警百分率的差别均有统计学意义。结论医院血流感染病原菌分布较广,耐药情况较为严重,临床医师重视血培养的送检,根据药敏结果及时调整抗菌药物的使用,避免抗菌药物滥用,尽量控制耐药菌的流行。OBJECTIVE To analyze the distribution,drug resistance and alarm time of gram-negative bacteria causing bloodstream infection,so as to help to carry out clinical infection treatment.METHODS Culture,identification and drug sensitivity test of gram-negative bacteria isolated from blood cultures from Jan.2012 to Sep.2016 were performed by using automatic blood culture apparatus and automatic identification system,and the positive a larm time and epidemiological characteristics were analyzed.RESULTS A total of 2488 strains of gram-negative bacteria were isolated from Jan.2012 to Sep.2016.They were dominated by Escherichia coli,Klebsiella pneumoniae,Acinetobacter baumannii,and Pseudomonas aeruginosa,accounting for 39.51%,19.69 %,9.65 %,and 8.24%,respectively.The sensitive rates of E.coli to irnipenem and meropenem were both 99.59% and the drug resistant rates to ciprofloxacin and levofloxacin were high,which were greater than 60%.The resistant rates of K.pneumoniae to imipenem and meropenem were 16.53% and 13.27%.Except sulfamethoxazole/trimethoprim （40.83%）,the sensitive rates ofA.baumannii to other antibiotics were all lower than 30%.E.cloacae （0.59d）had the shortest average positive alarm time of gram-negative bacteria,followed by E.coli,Enterobacter aerogenes,A.baumannii,and K.pneumoniae.E.coli,Enterobacter cloacae,Enterobacter aerogenes,K.pneumonia were positive for 40% in0.5d.However,in the non fermenting bacteria,P.aeruginosa,Stenotrophomonasmaltophilia,and Burkeholderia cepacia were positive for less than 10% in 0.5d.Except B.cepacia （30.77 %）,the positive rate could reach rnore than 75% in 1d.There were significant differences in the positive rates of 0.5d,1.0d and 2.5d among different strains.CONCLUSION Our hospital has a wide distribution of pathogens causing bloodstrearn infections,and the drug resistance is serious.Therefore,clinicians should pay more attention to blood culture,and adjust the usage of antibiotics according to the results of drug sensitivity,so as to avoid the abuse of antibioti

关 键 词：血流感染 革兰阴性菌 流行病学特征 耐药性 阳性报警时间 

分 类 号：R378[医药卫生—病原生物学]