重症医学科患者血流感染病原菌分布及耐药性分析  

Analysis on distribution and drug resistance of pathogenic bacteria in patients with bloodstream infection in intensive care units

作　　者：张荣芳 李轶[2] 钱磊[1] 霍剑锋 ZHANG Rongfang;LI Yi;QIAN Lei;HUO Jianfeng(Department of Clinical Laboratory,83rd Group Hospital of the PLA,Xinxiang,Henan 453000,China;Department of Clinical Laboratory,Henan Provincial People′s Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]中国人民解放军陆军第八十三集团军医院检验科,河南新乡453000 [2]河南省人民医院检验科,河南郑州450003

出　　处：《检验医学与临床》2021年第11期1543-1545,1550,共4页Laboratory Medicine and Clinic

基　　金：河南省医学科技攻关计划省部共建项目(SBGJ2018084)。

摘　　要：目的了解重症医学科患者血流感染病原菌的分布特点及耐药情况,为临床诊断和合理选用抗菌药物提供依据。方法回顾性分析重症医学科2018年1月1日至2019年5月31日送检的血培养标本,对分离出的病原菌分布及其耐药性进行分析。数据统计分析采用WHONET5.6软件。结果793份血培养标本中,共分离出病原菌107株,阳性率为13.5%。其中革兰阴性菌78株,占所分离病原菌的72.9%,主要为肺炎克雷伯菌;革兰阳性菌20株,占所分离病原菌的18.7%,主要为葡萄球菌属;真菌6株,占所分离病原菌的5.6%,主要为热带念珠菌。药敏试验显示,革兰阴性菌主要对亚胺培南、美罗培南、阿米卡星和哌拉西林/三唑巴坦等敏感率较高,对氨苄西林、氨曲南和头孢唑啉等耐药率较高;革兰阳性菌主要对万古霉素和利奈唑胺等高度敏感,对青霉素、红霉素耐药率较高。结论该研究中的重症医学科患者血流感染以革兰阴性菌为主,临床医师应根据病原菌药敏结果合理选用抗菌药物,降低重症患者细菌耐药率,从而有效预防和控制感染,提高患者治愈率。Objective To investigate the distribution characteristics and drug resistance of pathogenic bacteria isolated from patients with bloodstream infection in critical care unit,and to provide reference for clinical diagnosis and rational selection of antimicrobial agents.Methods The blood culture specimens from January 1st,2018 to May 31st,2019 were reviewed,and the distribution of isolated pathogens and their drug resistance were analyzed.WHONET5.6 software was used to analyze the data statistically.Results A total of 107 strains of pathogenic bacteria were isolated from 793 samples,the positive rate was 13.5%.Among them,78 strains of Gram-negative bacteria were accounted for 72.9%of the total isolated strains,which were mainly Klebsiella pneumoniae,while 20 strains of Gram-positive bacteria were accounting for 18.7%of the total isolated strains,which were mainly Staphylococcus.Six strains of fungi accounting for 5.6%of the isolated strains were mainly Candida tropicalis.The antibiotic sensitive test indicated that the Gram-negative bacteria were mainly sensitive to imipenem,meropenem,amikacin and piperacillin/trizobactam,and had high resistance to ampicillin,amtronen and cefazolin.The Gram-positive bacteria were highly sensitive to vancomycin and linezolamide and had high resistance to penicillin,erythromycin and clindamycin.Conclusion Gram-negative bacteria are the main source of bloodstream infection in the patients in intensive care unit of the hospital.Clinicians should reasonably select antimicrobial agents according to the results of pathogen susceptibility,so as to reduce the bacterial resistance rate of severe patients,effectively prevent and control infection,and improve the cure rate of patients.

关 键 词：重症患者 血流感染 病原菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学]