407株血培养分离菌的菌种分布及耐药性分析

Distribution and Antimicrobial Resistance Analysis of 407 Strains Isolated from Blood

目的了解医院血培养病原菌分布及主要菌种的耐药性,为临床抗菌药物的选用提供科学依据。方法血培养采用BacT/Alert 3D 120全自动血培养仪,细菌鉴定用ATB Expression仪,药敏试验采用K-B法。结果 2006年1月-2008年12月住院和门诊患者送检的血培养标本共4225份,培养阳性396份,阳性率9.4%,共检出病原菌407株;分离菌以革兰阴性杆菌为主,共265株,占65.1%;革兰阳性球菌130株,占31.9%;真菌12株,占3.0%;亚胺培南、美罗培南对大肠埃希菌、肺炎克雷伯菌全部敏感,但铜绿假单胞菌和鲍氏不动杆菌对碳青酶烯类药物的耐药率分别为38.9%、56.1%;鲍氏不动杆菌对三、四代头孢菌素、阿米卡星和环丙沙星的耐药率均为≥64.9%,多数菌株已成多药耐药或泛耐药株;3种葡萄球菌对万古霉素、米诺环素、替考拉宁和呋喃妥因仍高度敏感,对红霉素耐药率为71.4%～85.7%,克林霉素的耐药率分别为42.9%～67.2%,对于红霉素耐药而克林霉素敏感的菌株,必须通过诱导试验加以确诊,以免误导临床用药。结论医院血培养病原菌以革兰阴性杆菌为主,不同菌种耐药性差异很大;加强血培养病原菌及其耐药性监测,对于合理使用抗菌药物,减少耐药菌产生都有重要意义。

OBJECTIVE To investigate the distribution and drug-resistance of the bacteria isolated form blood culture to provide the scientific evidence for clinical therapy.METHODS Blood was cultured by BacT/Alert 3D 120,bacteria were identified by ATB automated bacteria identification instrument and drug sensitivity were tested used by K-B method.RESULTS From Jan 2006 to Dec 2008,there were 407 strains isolated from 4225 samples,396 cultured were samples（9.4%） positive.There were 265（65.1%） Gram-negative bacteria,130（31.9%） Gram-positive bacteria and 12（3.01%） fungi.Imipenem and meropenem were sensitive for Escherichia coli and Klebsielle penumoniae.The risistant rate of Pseudomonas aeruginosa and Acinotobacter baumannii to carbapenems was 38.9% and 56.1%.The resistant rates of A.baumannii to the third and fourth generation cephalosprins,amikacin and ciprofloxacin were more than 64.9%,and the most of them were multi-drug or pan-drug strains.Staphylococcus aureus,S.epidermidis and S.haemolyticus had high sensitivity to vancomycin,minocycline,teicoplanin and nitrofurantoin,and their drug-resistance rates to erythromycin and clindamycin were 71.4%-85.7% and 42.9%-67.2%.D-test was necessary for those strains which were sensitive to erythromycin but resistant to clindamycin.CONCLUSIONS Gram-negative bacteria are common among the microorganisms isolated from blood culture and their resistance are quite different.It＇s necessary to monitor and analyze the bacteria and their resistance for using antimicrobial agents reasonably and reducing the emergence of drug-resistant strains.