576株血培养分离菌的临床分布及耐药性变迁

Clinical distribution and antibiotics resistance of 576 strains isolated from blood specimens

目的了解血培养分离菌的临床分布特征及耐药性变迁。方法对2004-2006年安徽医科大学第一附属医院血培养阳性的样本进行细菌鉴定和药物敏感性试验，并对结果进行分析。结果6203份血培养样本中共分离出各类菌株576株，其中革兰阳性球菌占57．8％（333／576），革兰阴性杆菌占31．4％（181／576）。常见的分离菌分别为凝固酶阴性葡萄球菌、大肠埃希菌、金黄色葡萄球菌、草绿色溶血链球菌、肺炎克雷伯菌和真菌等。其中耐甲氧西林凝固酶阴性葡萄球菌约占78．3％（155／198）。主要革兰阴性杆菌对亚胺培南、哌拉西林／他唑巴坦及阿米卡星有较高敏感率。结论由耐甲氧西林凝固酶阴性葡萄球菌、产ESBLs的革兰阴性杆菌和真菌等引起的血流感染呈上升趋势，血培养分离菌株对常用抗菌药物的耐药性增加。

Objective To investigate the distribution and antibiotics resistance in blood culture isolates. Methods The clinical isolates of blood specimens from patients in the First Affiliated Hospital of Anhui Medical University during 2004 to 2006 were identified and the drug resistance to antimicrobial agents was tested. The results were analyzed and compared with those during 1986 to 1998. Results A total of 576 strains were isolated from 6203 blood specimens, among which grain positive cocci and gram negative bacilli account for 57.8% （333/576） and 31.4% （ 181/576）, respectively. The frequent isolates were coagulase negative Staphylococcus, Escherichia coli, Staphylococcus aureus, hemolytic Streptococcus viridans, Klebsiella pneumoniae and fungi. The methicillin-resistant coagulase negative Staphylococci （MRCNS） accounted for 78.3% （155/198）. Gram negative bacilli were highly susceptible to imipenem, piperacillin/ tazobactam and amikacin. Conclusions The incidence of bloodstream infections caused by MRCNS, gram negative bacilli producing ESBLs and fungi are increasing. The clinical isolates from blood have high resistance to the first line antibiotics.