近5年血培养中细菌分布及耐药性分析

Analysis on Distribution and Drug-resistance of Pathogens Isolated from Blood Culture in Past Five Years

目的监测和分析本院近5年来感染患者血培养中的病原菌分布和耐药特点,为临床抗感染治疗提供依据。方法血标本采用BACTEC9120全自动血培养仪培养,采用VITEK系统鉴定细菌,Kirby-Bauer琼脂扩散法进行体外药敏试验,应用WHONET5.3软件分析血培养标本所分离病原菌的分布和药敏结果。结果从2004年10月～2009年9月,血培养共检出985株病原菌,其中革兰阳性球菌487株,占49.4%;革兰阴性杆菌453株,占46.0%;真菌45株,占4.6%,检出的前几位细菌分别为凝固酶阴性葡萄球菌、大肠埃希菌、肠球菌属、克雷伯菌属、金黄色葡萄球菌和铜绿假单胞菌。中心重症监护室(ICU)、急诊科病房、血液科病房分离菌所占比例分别为23.1%、13.8%、12.7%。大肠埃希菌中ESBLs的检出率为36.9%,克雷伯菌属中ESBLs的检出率为32.8%,葡萄球菌中MRSA的检出率为21.2%,MRCNS的检出率为76.3%。亚胺培南与美罗培南对大肠埃希菌和肺炎克雷伯菌作用效果较好,葡萄球菌属对万古霉素100.0%敏感,其余抗菌药物均有不同程度的耐药。结论血培养分离的病原菌以革兰阳性菌为主,且菌种多样化,具有较高的耐药率,提示临床医生应做血培养,以合理应用抗菌药物,防止抗生素滥用及新耐药菌株的产生。

Objective A surveillance was performed to investigate the characteristics of distribution and antimicrobial resistance of microorganisms isolated from blood cultures in the past five years in our hospital,so as to provide evidence for the clinical therapy of infections.Methods Blood samples were cultured by BACTEC9120 System,microorganisms were identified by VITEK System and K-B method was used for the antibiotics susceptibility test.Results were analyzed based on WHONET5.3 software.Results A total of 985 strains of pathogenic bacteria were collected from October 2004 to Septemper 2009,including 487（49.4%）strains of gram-positive cocci,453（46.0%）strains of gram-negative bacilli and 45（4.6%）strains offungi.The main isolated bacteria were CONS,E.coli,Enterococcus,Klebsierlla,S.aureus and P.aeruginosa.The percentages of isolated bacteria in intensive care unit,emergency department and hematological department were 23.1%,13.8%,12.7% respectively.The detectable rates of E.coli,Klebsierlla of ESBLs,MRSA and MRCNS of Staphylococcus were 36.9%,32.8%,21.2% and 76.3%,respectively.E.coli and Klebsiella pneumoniae were sensitive to imipenem and meropenem,all the antibacterial drug lost efficacy in some degree,except that the sensitivity of the Staphylococci to vancomycin was 100%.Conclusions Gram-positive Cocci are the main bacteria in blood culture,the species from which are diversified,and the rate of drug resistance to some bacteria is high.It indicated that doctors should take more blood culture and monitor the bacteria drug resistant for the data of etiology,so that they can utilize antibiotics more reasonably to prevent the abuse of antibiotics and the emergence of new drug-resistant strains.