2006-2008年血培养主要病原菌的分布与耐药性变迁

Distribution and Drug Resistance Changes of Bacteria Isolated from Blood Specimens

目的了解医院2006-2008年血培养分离病原菌的构成比及耐药情况变迁的特点。方法患者血培养标本经BacT/Alert240血培养仪培养,分离所得菌株用法国生物梅里埃公司API系统进行鉴定,药敏用K-B法,用WHONET5.4软件对2006-2008年血培养结果进行回顾性统计分析。结果革兰阴性菌是导致血行性感染的主要病原菌,其中大肠埃希菌稳居2006-2008年血行性感染病原菌的首位,肺炎克雷伯菌、铜绿假单胞菌及金黄色葡萄球菌也是导致血液感染的重要病原菌,表皮葡萄球菌、溶血葡萄球菌等凝固酶阴性葡萄球菌和铜绿假单胞菌血行性感染有上升趋势;亚胺培南和美罗培南对血行性感染大肠埃希菌和肺炎克雷伯菌的敏感率达100.0%,其次是阿米卡星和头孢西丁,且2008年的敏感率较之前2年有上升趋势;各类抗菌药物对血行感染铜绿假单胞菌的敏感率普遍较低,且此菌耐药性明显上升;血行感染鲍氏不动杆菌的耐药情况严重,除对亚胺培南和美罗培南的敏感率较高且有所上升(20.0%～69.2%)外,对其他药物的敏感率均低(0～41.7%),万古霉素、替考拉宁、喹奴普汀/达福普汀对血培养分离的金黄色葡萄球菌抗菌活性强,未出现耐药菌株。结论血行性感染细菌种类及耐药性发生变化,加强血行性感染细菌的耐药性监测,对合理使用抗菌药物非常重要。

OBJECTIVE To investigate the distribution and the drug resistance changes of the pathogenic bacteria isolated from the blood culture specimens collected during the period of 2006--2008. METHODS Blood culture of patients in our hospital was performed by BacT/ Alert 240 and the isolated bacteria were identified by API and Microscan and tested for drug resistance against antimicrobial agent by K-B method. A retrospective analysis was made to the blood culture results during the period of 2006--2008 with WHONET 5.4 software. RESULTS Gramnegative rods were the predominant bacteria which caused sepsicemia. The isolated rates of Escherichia coli took the first place during the period of 2006--2008. Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus （SAU） were also the most important pathogens which caused blood infection. The infection rate of coagulase negative staphylococcus （CNS） and P. aeruginosa had increasing tendency. Imipenem and meropenem were the most effective antibiotics （100%） to E. coli and K. pneumoniae. Then amikacin and cefoxitin also had high susceptibility to E. coli and K. pneumoniae. Furthermore, drug susceptibility in 2008 was higher than that of two years before. All antibacterials had low drug susceptibility to P. aeruginosa, and its drug resistance rate rised obviously. The drug resistance situation of Acinetobacter baumannii was serious. Except imipenem and meropenem had relatively higher susceptibility （20-69. 2%）, the susceptibility to other antibacterials was lower than 41.7 %. Vancomycin, teicoplanin and quinupristin/dalfopristin were the most effective antibiotics to （SAU）. CONCLUSIONS The species and drug resistance of the bacteria isolated from blood specimens have changed. More attention should be paid to the detection and surveillance of bacterial resistance in blood culture to promote the rational use of antibiotics.