血培养病原菌的分布及耐药性分析

Analysis of drug resistance and distribution of Pathogenic bacteria in blood cultures

目的:了解我院引起菌血症的病原菌分布及常见致病菌的耐药情况,为临床合理用药提供依据。方法:回顾性分析医院3年间血培养结果;血培养采用Bact/ALERT3D全自动血培养仪,鉴定和药敏采用VITEK-60细菌鉴定仪,药敏结果用WHONET5.3软件进行分析。结果:从11102例血培养中分离基础病原菌2082株,阳性率为18.75%;其中,革兰阳性菌1571株,占75.46%,主要以凝固酶阴性葡萄球菌、金黄色葡萄球菌为主;革兰阴性菌477株,占22.91%,主要以大肠埃希菌、肺炎克雷伯伯氏菌、鲍氏不动杆菌为主;真菌32株,占1.53%,以白色念珠菌为主。耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)占83.61%,耐甲氧西林金黄色葡萄球菌(MRSA)占52.88%;大肠埃希菌和肺炎克雷伯氏菌的超广谱β-内酰胺酶(ESBLs)检出率为43.97%和24.21%。结论:血培养检出菌种类多,耐药率高,临床应加强对疑似病例血液中病原菌的检测,根据药敏监测结果合理用药。

Objective：To investigate the distribution and antibiotic resistance of pathogens isolated in blood culture from the impatients,and to provide basis for clinical rational utilization of antibiotics.Methods： Retrospective analysis was taken for blood culture specimens during 3 years in our hospital.A total of 11102 blood samples were cultured by Bact/ALERT 3D system,strains isolated were taken to VITKE-60 automatic microbiological analysis/sensitivity system for identification and drug susceptibility testing.Drug susceptibility results were analyzed using WHONET 5.3 software.Results： Totally 2082 pathogen were isolated from 11102 cases of blood culture sample and the positive rate was 18.75%.1571 Gram-positive bacteria accounted for 75.46%,mainly Coagulase negativestap hyococcus,S.aureus dominated.477 Gram-negative bacteria strains accounted for 22.91%,mainly Escherichia coli,Klebsiella pneumoniae,and Acinetobacter baumannii dominated.Fungi were 32 strains（1.53%）,mainly Candia albicans.Meticillirr-resistant S.aureus and coagulase-negative staphylococci were 52.88%and 83.61%,respectively.Extended-spectrum β-lactamases（ESBLs） produced by E.coli and K.pneumoniae strains were 43.97%and 24.21%,respsectively.Conclusion： The bacteria identification detected in blood culture class is quite complicated,and the drug resistance is high.Clinicians should pay attention to the culture of blood in patients suspected septicemia,so as to use antimicrobial agents rationally.