近3年血培养中病原菌的分布及耐药状况分析

The distribution and drug resistance analysis of pathogenic bacteria isolated from blood samples during the last three years

目的了解血培养中病原菌的菌群分布及其耐药状况。方法患者血培养标本经Bact/Alert 3D自动血培养仪和ATB Expression鉴定仪进行血培养及鉴定,用Kirby-Bauer纸片扩散法进行药敏试验。结果在2593例血培养标本中分离出细菌189株,阳性检出率为7.3%。其中革兰阴性杆菌100株,占52.91%;革兰阳性球菌80株,占42.34%。最常见的6种分离菌依次为大肠埃希菌(26.46%)、表皮葡萄球菌(14.29%)、肺炎克雷伯杆菌(13.23%)、溶血葡萄球菌(11.11%)、金黄色葡萄球菌(6.35%)、铜绿假单胞菌(6.35%)。其中革兰阴性杆菌对亚胺培南、美洛匹宁较敏感;革兰阳性球菌对万古霉素、呋喃妥因、替考拉宁治疗较敏感。结论大肠埃希菌、肺炎克雷伯菌、葡萄球菌是血培养中的主要病原菌。血培养分离株对常用抗菌药耐药现象严重,提示应高度重视合理使用抗生素,以提高临床治疗效果。

Objective To investigate the distribution and drug resistance situation of pathogenic bacteria isolated from blood samples. Methods Blood culture samples were analyzed with Bact/Alert 3D automated hemanalysis system and pathogenic bacteria were identified with ATB Expression identification analyzer. Kirby-Bauer disk diffusion method was employed to perform drug sensistivity test. Results A total of 189 （7.3%） strains of bacteria were isolated from 2 593 cases of blood samples. The detected strains （%） of gram negative bacilli and gram positive cocci were 100 （52.91%） and 80 （42. 34%） respectively. The six most common isolated bacteia were Escherichia coli （26. 46%）, Staphylococcus epidermidis （14. 29%）, Klebsiella pneumoniae （ 13.23%）, Staphylococcus haemlyticus （ 11.11% ）, Staphylococcus aures （6.35% ） and Pseudomonas aeruginosa （6.35%） respectively. Drug sensitivity test showed that gram negative bacilli were more sensitive to imipenem and meropenem, while gram positive cocci were more sensitive to vancomycin, nitrofurantoin and teicoplanin. Conclusion Escherichia coli, Klebsiella pneumoniae and Staphylococci were dominant pathogenic bacteria in blood culture samples. The drug resistance statue of isolated strains is serious. It suggests that antibiotics be used rationally so as to enhance clinical therapeutic efficacy.