近10年血培养分析及血中719株常见细菌的耐药性

Blood Culture and Antimicrobial Resistance of 719 Strains of Bacteremia in Recent 10 Years: Analysis of Results

目的了解我院10年来血培养的送检、检出以及血中常见细菌的药敏情况,指导临床对菌血症的治疗。方法利用WHONET5.2和EXCEL软件分析细菌分布、种类变化及纸片扩散药敏数据。结果我院自1994年1月～2003年11月30日共送检血液培养标本15262份,平均分离阳性率为8.1%,其中细菌1130株占91.0%;真菌9.0%;在凝固酶阴性葡萄球菌和金黄色葡萄球菌中MRSCN和MRSA分别为71.7%和36.4%,目前未发现对万古霉素耐药的葡萄球菌、粪肠球菌和屎肠球菌,但有8.7%、1.7%的屎肠球菌、粪肠球菌处于中介;血中产ESBLs的克雷伯菌和大肠埃希菌分别为15%和24.8%,在阴沟肠杆菌、克雷伯菌和大肠埃希菌中,克雷伯菌对环丙沙星的敏感性最高75%;铜绿假单胞菌和不动杆菌对阿米卡星、环丙沙星和头孢他啶耐药性较低,分别为2.0%、19.2%;9.8%、19.2%和11.8%、23.1%;有17.6%的铜绿假单胞菌对亚胺培南耐药,目前没有对亚胺培南耐药的阴沟肠杆菌、克雷伯菌、大肠埃希菌和不动杆菌。结论目前我院菌血症仍以革兰阴性菌为主,引起菌血症的种类不同耐药性差异较大,及时了解血培养结果对临床有针对性地抗菌治疗提供依据,降低病死率,提高治愈率。

OBJECTIVE To evaluate the method of blood culture and to understand the resistance trend of ~commonly isolated bacteria. METHODS The data of bacterial distribution and antimicrobial susceptibility from 1994 to 2002 were analyzed by WHONET5.2 and EXCEL software. RESULTS The six major pathogens isolated from blood were Escherichia coli, coagulase-negative Staphylococcus, Pseudomonas aeruginosa, Enterococcus, ~S. aureus, Klebsiella pneumoniae, respectively, in recent 10 years. MRCNS and MRSA were 71.7% and 36.4% among coagulase-negative staphylococci and S. aureus. None of the Staphylococcus and Enterococcus showed ~resistance to vancomycin. 1.7% of E. faecalis and 8.7% of E. faecium, however, showed intermediate ~resistance to vancomycin. ESBLs-producing K. pneumoniae and ESBLs-producing E. coli were 15% and ~24.8%. In Gram negative rods the resistance of K. pneumoniae to ciprofloxacin was the lowest, which was ~25.5%. The resistance rate of P. aeruginosa and Acinetobacter spp, showed 2% and 19.2% to amikacin; 9.8% and 19.2% to ciprofloxacin; 11.8% and 23.1% to ceftazidime, respectively. None of the Enterobacter and Acinetobacter spp showed resistance to imipenem. But the resistance of P. aeruginosa to imipenem was 17.6%. CONCLUSIONS The major pathogens isolated from blood were Gram negative rods in our hospital in recent ~10 years. It is different resistance of difference strains giving rise to bacteremia. Clinical physician ought to ~understand the characteristics, select antimicrobial agents correctly and efficiently, and enhance rate of cure of ~bacteremia.