血培养标本中病原菌的分布特征、耐药性变迁和耐药基因分型  

The research in distribution,drug resistance and drug-resistant genes of pathogenic bacteria in blood cultures

作　　者：陈兴英 楼永良[1] CHEN Xingying;LOU Yongliang(Wenzhou Medical University,Wenzhou,Zhejiang 325000,China;Department of Clinical Laboratory,the Affiliated Jiaxing Hospital of Traditional Chinaese Medicine,Zhej iang Chinaese Medicine University,J iaxing,Zhej iang 314001,China)

机构地区：[1]温州医科大学,浙江温州325000 [2]浙江中医药大学附属嘉兴市中医医院检验科,浙江嘉兴314001

出　　处：《中国微生态学杂志》2018年第7期810-817,共8页Chinese Journal of Microecology

摘　　要：目的分析嘉兴市中医医院血培养标本中病原菌的分布特征、耐药性变迁和耐药基因分型。方法将本院2013年1月至2016年12月送检的血培养标本进行培养、转种、分离鉴定和药敏试验,采用聚合酶链反应(PCR)技术进行产超广谱β-内酰胺酶(ESBLs)革兰阴性菌和革兰阳性菌的耐药基因检测,并对阳性菌株、科室分布、耐药性等相关数据进行分析。结果 2013年1月至2016年12月共送检血培养标本27 003份,共分离出病原菌(剔除重复菌株)978株,阳性率为3.62%,2015-2016年阳性率显著低于2013-2014年,差异有统计学意义(P<0.01)。血培养阳性株数前三位为ICU、儿科和肾内科,2015-2016年与2013-2014年相比,ICU的阳性株数构成比显著下降,儿科、呼吸内科和其他科室显著上升,差异有统计学意义(P<0.01)。血培养致病菌检出率最高的为大肠埃希菌,占18.51%,其次为表皮葡萄球菌,占10.53%,不可忽视的是真菌,占4.91%。2015-2016年与2013-2014年相比,金黄色葡萄球菌检出率显著上升,粪肠球菌和近平滑假丝酵母菌的检出率显著下降,差异有统计学意义(P<0.05)。血培养分离的大肠埃希菌对氨苄西林的耐药率最高,肺炎克雷伯菌对呋喃妥因的耐药率最高。2015-2016年与2013-2014年相比,大肠埃希菌对氨苄西林/舒巴坦和庆大霉素的耐药率显著下降(P<0.01),肺炎克雷伯菌对庆大霉素的耐药率显著上升(P<0.01)。分离的表皮葡萄球菌和金黄色葡萄球菌对青霉素的耐药率最高,2015-2016年与2013-2014年相比,表皮葡萄球菌对红霉素和氯洁霉素的耐药率显著下降(P<0.01),金黄色葡萄球菌对环丙沙星和左氧氟沙星的耐药率显著下降(P<0.01)。大肠埃希菌ESBLs(+)菌株对氨苄西林、氨苄西林/舒巴坦、头孢唑啉等的耐药率以及所有基因型表达率均显著高于ESBLs(-)菌株(P<0.05或P<0.01);肺炎克雷伯菌ESBLs(+)菌株对头孢唑啉、头孢曲松、庆大霉素等的耐药率�Objective To analyze the distribution,drug resistance and gene types of pathogenic bacteria in blood cultures from 2013 to 2016 in our hospital.Methods The blood specimens were cultured to isolate pathogenic bacteria and detect their drug sensitivity.The drug resistant genes of ESBLs producing bacteria were tested using PCR,and the positive strains,their distribution and drug resistance were analyzed.Results Among the total 27,003 blood specimens,978 strains（3.62%）of pathogenic bacteria were isolated（excluding repeated strains）.The isolation rate in 2015/2016 was obviously higher than in 2013/2014（P〈0.01）.The highest isolation rate was seen in ICUs,followed by pediatrics and nephrology departments.The isolation rate in ICUs in 2015/2016 was obviously lower than in 2013/2014,while those in pediatrics,respiratory and other departments were obviously higher（Ps0.01）.The detection rate of Escherichia coli was the highest（18.51%）,followed by that of coagulase negative Staphylococci（10.53%）.Fungi accounted for 4.91%.The detection rate of Staphylococcus aureus in 2015/2016 was obviously higher than in2013/2014,while those of Enterococcus faecalis and Candida parapsilosis were obviously lower（Ps0.05）.The resistance rate of Escherichia coli to Ampicillin was the highest,while Klebsiella pneumoniae showed the highest resistance to Furantoin.The resistance rates of Escherichia coli to Ampicillin/Sulbactam and Gentamycin in 2015/2016 were obviously lower than in 2013/2014（Ps0.01）,while that of Klebsiella pneumoniae to Gentamycin was obviously higher（P〈0.01）.Staphylococcus epidermidis and Staphylococcus aureus were most sensitive to Penicillin.The resistance rates of Staphylococcus epidermidis to Erythrocin and Clindamycin in 2015/2016 were obviously lower than in 2013/2014（Ps0.01）,while those to Ciprofloxacin and Levofloxacin were obviously lower（Ps0.01）.The resistance rate of ESBLs（＋）Escherichia coli to Ampicillin,Ampicillin/Sulbactam and Cefazolin,as well as the expressi

关 键 词：血培养 病原菌 耐药性 耐药基因 革兰阳性球菌 革兰阴性杆菌 

分 类 号：R446.5[医药卫生—诊断学]