10年综合性ICU血培养阳性病原学回顾性分析  

Retrospective analysis of pathogens in positive blood culture in general intensive care unit for 10 years

作　　者：石齐芳 盛鹰 杨光耀 郑文龙 毛爱华 蔡金芳 王静恩 王树云 Shi Qi-fang;Sheng Ying;Yang Guang-yao;Zheng Wen-long;Mao Ai-hua;Cai Jin-fang;Wang Jing-en;Wang Shu-yun(Department of Emergency and Critical Care Medicine,Shanghai Pudong Hospital,Fudan University Pudong Medical Center,Shanghai 201399;Department of Clinical Laboratory,Shanghai Pudong Hospital,Fudan University Pudong Medical Center,Shanghai 201399;Department of Healthcare-Associated Infection Control,Shanghai Pudong Hospital,Fudan University Pudong Medical Center,Shanghai 201399)

机构地区：[1]上海市浦东医院复旦大学附属浦东医院急危重医学科,上海201399 [2]上海市浦东医院复旦大学附属浦东医院检验科,上海201399 [3]上海市浦东医院复旦大学附属浦东医院感染控制科,上海201399

出　　处：《中国抗生素杂志》2020年第10期1084-1091,共8页Chinese Journal of Antibiotics

基　　金：上海市浦东新区卫生系统优秀青年医学人才培养计划(No.PWRq2017-29);上海市浦东新区卫生系统重点学科建设(No.PWZxk2017-20)。

摘　　要：目的分析近10年我院综合ICU血培养阳性标本病原菌的分布及耐药性情况。方法回顾性调查分析2009年1月—2018年12月我院ICU住院患者临床血培养阳性标本病原菌及药敏试验结果。结果①共分离出病原菌424株,其中革兰阳性菌占56.0%,革兰阴性菌占38.9%,真菌占6.1%。按病原学检出率排前6位的分别为表皮葡萄球菌(19.6%)、大肠埃希菌(18.4%)、金黄色葡萄球菌(13.0%)、肺炎克雷伯菌(8.3%)、屎肠球菌(6.4%)、溶血葡萄球菌(5.2%)。②近5年(2014—2018年)凝固酶阴性葡萄球菌(CNS)的检出率,相比前5年(2009—2013年)明显下降(25.0%vs 39.4%,χ2=10.117,P=0.001),但CNS内各细菌检出率比较差异均无统计学意义(P>0.05);肠杆菌科细菌近5年总检出率较前5年明显上升(36.6%vs 27.4%,χ2=4.090,P=0.043),其中大肠埃希菌的检出率上升最为明显(22.2%vs 13.9%,χ2=4.293,P=0.038),肺炎克雷伯菌的检出率也为上升趋势(10.6%vs 5.8%,χ2=3.331,P=0.068),其他肠杆菌科细菌检出率呈下降趋势,但差异无统计学意义(P>0.05);金黄色葡萄球菌、肠球菌、非发酵革兰阴性菌、真菌的检出率比较,差异均无统计学意义(P>0.05);近5年耐甲氧西林金黄色葡萄球菌(MRSA)的检出率明显低于前5年(38.7%vs 66.7%,χ2=4.231,P=0.040),耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率基本无变化(66.7%vs 70.7%,χ2=0.252,P=0.616);近5年大肠埃希菌产ESBL(+)分离率较前5年有明显下降趋势(18.8%vs 40.0%,χ2=4.231,P=0.040),而肺炎克雷伯菌及奇异变形菌产ESBL(+)分离率差异均无统计学意义(P>0.05);近5年真菌检出率较前5年上升,但差异无统计学意义(6.0%vs 2.4%,χ2=0.679,P=0.410)。③未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌,屎肠球菌中检出万古霉素和替考拉宁耐药菌2株,未检出对利奈唑胺耐药的肠球菌;肺炎克雷伯菌对碳氢酶烯类耐药率为17.1%,未发现对碳青霉烯类药物耐药的大肠埃希菌及奇�Objective To investigate the distribution and antimicrobial resistance of pathogens in positive blood culture in the past ten years in general intensive care unit.Methods Pathogenic bacteria isolated from specimens of blood culture cases during the period of Jan.2009-Dec.2018 were identified and drug susceptibility tests were performed.Results①A total of 424 strains were isolated from blood specimens.Gram-positive cocci and Gramnegative bacilli accounted for 56.0%and 38.9%,respectively,and fungus accounted for 6.1%.According to the pathogen detection rate,the top six were Staphylococcus epidermis(19.6%),Escherichia coli(18.4%),Staphylococcus aureus(13.0%),Klebsiella pneumoniae(8.3%),Enterococcus faecalis(6.4%),and Staphylococcus hemolyticus(5.2%).②The detection rate of coagulase-negative staphylococci(CNS)in the last five years(2014—2018)was significantly lower than that in the previous five years(2009—2013)(25.0%vs 39.4%,χ2=10.117,P=0.001),but there was no statistically significant difference in the detection rate of all bacteria in GNS(all P>0.05).The total detection rate of Enterobacteriaceae bacteria in the last five years was obviously increased compared with the previous five years(36.6%vs 27.4%,2=4.090,P=0.043),the rising rate of Escherichia coli was most obvious(22.2%vs 13.9%,χ2=4.293,P=0.038),and the detection rate of Klebsiella pneumoniae was also rising(10.6%vs 5.8%,χ2=3.331,P=0.068),and the detection rate of other Enterobacteriaceae bacteria was downtrend,but the differences were not statistically significant(all P>0.05).There were no significant differences in the detection rates of Staphylococcus aureus,Enterococcus,nonfermented Gram-negative bacillus and fungus(all P>0.05).The detection rate of methicillin-resistant Staphylococcus aureus(MRSA)in the past five years was significantly lower than that in the previous five years(38.7%vs 66.7%,χ2=4.231,P=0.040),and the detection rate of methicillin-resistant coagulase-negative staphylococci(MRCNS)was unchanged(66.7%vs 70.7%,χ2=0.252,P=0.616

关 键 词：血培养 综合ICU 病原学 耐药性 

分 类 号：R978.1[医药卫生—药品]