某院2017—2018年血培养阳性标本菌群分布及耐药性分析  

Distribution and antimicrobial resistance of blood culture positive pathogens in a hospital during 2017-2018

作　　者：王林[1] 张昌峰[1] 梁浩杰 舒琳睿 朱俊[1] Wang Lin;Zhang Changfeng;Liang Haojie;Shu Linrui;Zhu Jun(Clinical Laboratory Center,the First Affiliated Hospital of Anhui University of Chinese Medicine,Hefei 230031,Anhui,China)

机构地区：[1]安徽中医药大学第一附属医院检验中心,安徽合肥230031

出　　处：《实用检验医师杂志》2020年第3期153-156,共4页Chinese Journal of Clinical Pathologist

基　　金：安徽中医药大学科研项目(2019zryb13)。

摘　　要：目的分析血培养标本菌群分布特点及耐药性,为临床血流感染(BSI)合理用药和感染控制提供依据。方法收集2017年1月—2018年12月安徽中医药大学第一附属医院门诊及住院患者血培养样本及临床资料,进行菌株鉴定和药敏试验,分析菌群分布及耐药性。结果共送检血培养标本3446份,检出首次非重复病原菌309株,阳性检出率为8.97%,其中革兰阳性(G+)菌、革兰阴性(G-)菌、真菌分别占52.75%(163/309)、38.83%(120/309)、8.41%(26/309)。居前5位的病原菌依次为大肠埃希菌、人葡萄球菌、表皮葡萄球菌、肺炎克雷伯菌及金黄色葡萄球菌,分别占18.12%(56/309)、11.65%(36/309)、11.00%(34/309)、7.44%(23/309)、6.47%(20/309)。大肠埃希菌对亚胺培南的耐药率明显低于肺炎克雷伯菌(0比26.09%,P<0.05),耐甲氧西林金黄色葡萄球菌(MRSA)检出率为50.00%,低于耐甲氧西林人葡萄球菌(72.22%)和耐甲氧西林表皮葡萄球菌(70.59%),未发现对万古霉素、利奈唑胺和替加环素耐药的葡萄球菌。屎肠球菌对多种常见抗菌药物的耐药率均明显高于粪肠球菌(均P<0.05)。结论血培养菌群分布复杂,耐药性差异大,以G+菌检出为主。应加强血培养病原菌分布及其耐药性差异监测,减少多重耐药菌的产生。Objective To analyze the distribution characteristics and drug resistance of pathogens in blood culture,and to provide basis for rational drug use and control of clinical bloodstream infection(BSI).Methods The clinical data and blood culture samples of outpatients and inpatients in the First Affiliated Hospital of Anhui University of Chinese Medicine during January 2017 to December 2018 were collected.The bacterial identification and drug sensitivity test were carried out,and bacterial distribution and drug resistance were analyzed.Results Totally 309 strains of pathogens were isolated from 3446 samples and positive rate was 8.97%,among which the proportion of Gram-positive(G+)bacteria,Gram-negative(G-)bacteria and fungi was 52.75%(163/309),38.83%(120/309)and 8.41%(26/309),respectively.The top five species of pathogens were Escherichia coli,Staphylococcus hominis,Staphylococcus epidermidis,Klebsiella pneumoniae and Staphylococcus aureus,accounting for 18.12%(56/309),11.65%(36/309),11.00%(34/309),7.44%(23/309)and 6.47%(20/309),respectively.The resistance rate of Escherichia coli to imipenem was significantly lower than that of Klebsiella pneumoniae(0 vs.26.09%,P<0.05).The detection rate of methicillin-resistant Staphylococcus aureus(MRSA)was 50.00%,which was lower than that of methicillin-resistant Staphylococcus hominis(72.22%)and methicillin-resistant Staphylococcus epidermidis(70.59%).No Staphylococcus spp.resistant to vancomycin,linezolid and tigecycline was found.The resistance rates of Enterococcus faecium to several common antibiotics were significantly higher than those of Enterococcus faecalis(all P<0.05).Conclusions The bacteria distribution in blood culture is complex,mainly G+bacteria,with significant difference in drug resistance.The distribution and drug resistance of pathogens in blood culture should be monitored to reduce the occurrence of multi drug resistant bacteria.

关 键 词：血培养 病原菌 耐药性 微生物 

分 类 号：R446.5[医药卫生—诊断学]