血培养常见病原菌菌群分布及耐药性分析

Analysis of the distribution and drug resistance of pathogenic bacteria in blood cultures

目的了解武汉市中心医院2007年7月至2009年9月血培养病原菌菌群分布及常见致病菌的耐药情况,为临床合理应用抗菌药物提供参考。方法采用美国BD公司BACTEC9050全自动血培养仪进行培养检测,分离出的致病菌用法国生物梅里埃公司API鉴定系统进行鉴定,药敏试验采用纸片扩散法,以2007版美国临床实验室标准化研究所标准对药敏试验结果进行判定,运用WHONET5.4软件进行分析。结果 2256例标本共分离出病原菌269株,血培养阳性率11.9%,检出革兰阳性菌129株(47.96%);革兰阴性菌116株(43.12%);真菌24株(8.92%)。主要致病革兰阳性菌对万古霉素、替考拉宁、利奈唑胺100%敏感,大肠埃希菌和肺炎克雷伯菌对亚胺培南、美罗培南100%敏感,铜绿假单胞菌和不动杆菌对头孢哌酮/舒巴坦较敏感。结论武汉市中心医院败血症的病原菌以条件致病菌为主,革兰阳性病原菌的分离率略高于革兰阴性菌,以葡萄球菌居多。病原菌的耐药情况严重,应及时监测病原菌变化及耐药趋势,指导临床用药。

Objective To offer the clinical physician the basis of optimal application of antibiotic,we have investigated the variation of antibiotic resistance and the bacterial distribution in the blood culture from July 2007 to Sept. 2009 in the central hospital of Wuhan. Methods Blood was cultured in BACTEC 9050（BD,US）. The clinical isolates were identified by API identified tests（Bio-Merieux company of France）. Kirby-Bauer method was used in antibiotic sensitivity test,and the results was analyzed By WHONET5.4 software, which was determined by the CI.SI standard of the edition in 2007. Results Of 2256 blood samples,the bacteria-positive samples were 269 （11.9%）. There were 129 strains of gram-positive cocci accounted for 47.96 %, 116 strains of Gram negative bacilli accounted for 43. 12%. 24 strains of fungi accounted for 8.92%. The antibiotic sensitivity test showed that the sen,sitivity of the main gram-positive bacilli to vancomycin, teieoplanin and iinezolid were 100 %, and Escherichia colt and Klebsiella pneumoniae to imipenem and meropenem were 100%, Pseudomonas aeruginosa and acinetobacter were highly suscep- tible to cefoperazone/sulbactam. Conclusion The most pathogenic bacteria isolated from blood are conditional patho- gens. gram positive bacilli is a little more than gram negalive bacilli,and the main bacteria was staphylococcus. Drug resistance of isolated pathogenic bacteria in blood cultures is very serious. It is of great importance in guiding the clinical therapy to monitor the change of pathogens and trends of drug resistance.