血培养标本的病原菌构成及耐药性分析

Distribution and Resistance Analysis of Isolates from Blood Culture Samples

目的了解医院2007年9月-2008年12月住院与门诊患者血培养分离病原菌分布和耐药状况。方法用BacT/Alert 3D全自动血培养仪对5045套血标本进行检测,采用K-B法按CLSI规定进行药敏试验,使用WHONET5.4软件进行分析。结果对于送检的5045套血标本中,检出病原菌408株,占8.1%;其中革兰阳性菌193株,占47.3%;革兰阴性菌197株,占48.3%;真菌17株,占4.2%;厌氧菌1株（0.2%）;分离最多为凝固酶阴性葡萄球菌121株,占29.7%;其次为大肠埃希菌76株,占18.6%、肠球菌属36株,占8.8%、克雷伯菌属29株,占7.1%和金黄色葡萄球菌18株,占4.4%;12 h内报警的病原菌主要为肠杆菌科细菌,尤其是大肠埃希菌;12-18 h主要为肠杆菌科和肠球菌属细菌;18-24 h主要为葡萄球菌属;24 h后主要为葡萄球菌属和真菌;未发现耐万古霉素葡萄球菌及耐碳青酶烯类肠杆菌,分离出对万古霉素和替考拉宁耐药的屎肠球菌,值得注意。结论及时了解血培养结果可以对临床抗菌治疗提供依据,提高治愈率,对控制医院感染具有重要意义。

OBJECTIVE To investigate the distribution and resistance of pathogenic bacteria isolated from the blood culture specimens collected during the period of Sept 2007 Dec 2008.METHODS The 5045 blood cultures were detected by BacT/Alert 3D automated blood culture system,and bacterial susceptibility test was conducted on all isolates using Kirby-Bauer methods with CLSI standards.WHONET 5.4 was applied for analysis of the bacterial sensitive data.RESULTS From the 5045 blood samples received,we identified 408 strains（8.1%） of pathogens in which 193 Gram-positive strains（47.3%）,197 Gram-negative strains（48.3%）,17 fungal strains（4.2%）,and 1 anaerobes strain（0.2%）.Coagulase-negative staphylococcus were 121 strains（29.7%）,Escherichia coli 76 strains（18.6%）,Enterococcus 36 strains（8.8%）,Klebsiella 29 strains（7.1%）,and Staphylococcus aureus 18 strains（4.4%）.The main pathogenic bacteria alarmed were Enterobacteriaceae,particularly was E.coli in 12 hours,Enterobacteriaceae and Enterococcus in 12-18 hours,Staphylococcus in 18-24 hours,and Staphylococcus and fungi after 24 hours.No Staphylococcus strain was resistant to vancomycin.No Enterobacteriaceae strain was resistant to carbapenems.Some isolates of E.faecium showed resistance to vancomycin and teicoplanin.CONCLUSIONS It is very important to obtain the results of blood culture in time for correct clinical therapy of bacterial infective diseases and to improve the cure rate and to control cross-infection in hospitals.