血培养的菌谱调查及耐药性分析

Bacterial Spectra Investigation of Blood Culture and Clinical Analysis of Resistance of Pathogens

目的了解医院血培养菌谱变化以及细菌耐药的变迁,为临床合理应用抗菌药物提供依据。方法美国BD公司的BACTEC 9120进行血液培养,细菌鉴定用法国生物梅里埃公司的API系列和VITEK-2仪器,药敏实验采用K-B纸片扩散法,用2005版NCCLS标准对结果进行判定,药敏结果用WHONET 5.3软件进行分析。结果1 468例患者培养阳性,革兰阳性球菌743株,占50.7%,革兰阴性杆菌565株,占38.5%,真菌93株,占6.3%,对5年的葡萄球菌属、大肠埃希菌、肺炎克雷伯菌进行了药敏结果分析,除葡萄球菌属对万古霉素100.0%敏感外,其余抗菌药物均有不同程度的耐药。结论血培养分离的病原菌以革兰阳性菌为主,且菌种多样化,具有较高的耐药率,提示临床医生应多做血培养,以便合理应用抗菌药物。

OBJECTIVE To offer the clinical physician the basis of optimal application of antibiotic, we have investigated the variation of antibiotic resistance and the bacterial spectra in the blood culture. METHODS Blood was cultured in BACTEC9120 of BD. The clinical isolates were identified by API and VITEK-2 of Bio-Merieux of France. Antibiotic susceptive test was clone by Kirby-Bauer method and the result which was analyzed by WHONET5. 3 and SPSSll. 5 software was determined by the NCCLS standard of 2005＇s edition. RESULTS Organisms were isolated from the blood specimen of 1468 patients, and there were 743 strains of Gram -positive cocci accounted for 50.7%, 565 strains of Gram-negative bacilli accounted for 38.5%. Ninety three strains of fun- gi accounted for 6.3%. We analyzed the drug-susceptive result of Staphylococcus, Escherichia coli, and Klebsiella pneumoniae during five years, and found that all the antibacterial drug lost efficacy in some degree, except that the sensitivity of the staphylococci to vancomycin was 100%. CONCLUSIONS Gram-positive cocci are the main bacteria in blood culture, the species from which are diversified, and the rate of the drug resistance of some bacteria is high. It indicated that doctors should take more blood culture and monitor the bacteria drug resistant for the data of etiology, so that they can utilize antibiotic more reasonably.