医院血培养的病原菌分布及耐药性分析

The distribution and resistance analysis of pathogen isolated from 1002 blood samples

目的了解我院2006年至2008年血培养中病原菌的阳性率、分布及其对药物的敏感情况,为临床治疗菌血症提供用药依据。方法采用自动血培养仪对血培养瓶进行连续培养监测,全自动微生物分析系统对血标本中分离的病原菌进行鉴定和药物敏感试验。结果1002份血培养标本分离出病原菌103株,阳性率10.3%,其中革兰阴性菌58株,占56.3%;革兰阳性菌32株,占31.9%;真菌10株,占9.7%。革兰阴性菌中,大肠埃希菌、肺炎克雷伯菌对氨苄西林的耐药率最高,分别为92.7%和92.3%。革兰阳性菌中,金黄色葡萄球菌、凝固酶阴性葡萄球菌对青霉素耐药率达100%,肠球菌对常用抗生素呈高度耐药,未发现葡萄球菌对万古霉素耐药,但有9.1%的肠球菌对万古霉素呈中介。结论目前我院血培养分离的病原菌分布较广,大肠埃希菌和葡萄球菌是菌血症和(或)败血症的主要病原菌;药敏结果提示检出菌耐药性严重且广谱耐药,及时准确的血培养结果能为临床合理选择抗菌药物提供重要依据。

Objective To investigate the positive rate, distribution and drug resistance of pathogenic bacteria in blood culture from 2006 to 2008 in the Third Affiliated Hospital of Sun Yat-sen University. Method Blood samples were incubated by automated blood culture analyzer and examined by automated microbial analyzer. Result Of 1002 blood sampies, 103 （ 10.3 % ） samples were positive, which contain 58 （ 56.3 % ） strains of gram-negative bacteria, 32 （ 31.9% ）strains of gram-positive bacteria and 10（9.7% ） strains of fungi. The resistance rate of Escherichia coli and Klebsiella pneumoniae to amppicillin were 92.7% and 92.3% respectively, Which were higher than other bacteria. Among the gram-positive strains, all Staphylococcus aureus and coagulase-negative staphylococci were resistant to Penicillin, Enterococcus also showed resistance to common antibiotics, while Staphylococci strains were sensitive to Vancomycin. However, 9.1% of Enterococcus strains showed intermediate resistance to Vancomycin. Conclusion Bacteria isolated from blood culture in our hospital distributed widely. Escherichia coli and Staphylococci were the main pathogenic bacteria in recent years. It was indicated that the majority of pathogen were severely resistant to many kinds of antibiotics. The laboratory analysis of microbiology should be reported timely and accurately to provide information for selecting antibiotic correctly and efficiently.