2004-2009年血培养标本中病原菌分布及其耐药性

Distribution and drug resistance of pathogens from blood culture samples during 2004-2009

目的分析血流感染病原菌及其耐药性,为临床抗感染治疗提供依据。方法回顾性分析2004年1月-2009年12月临床送检血培养标本所分离的病原菌及药敏试验结果。结果 7153份血培养标本中共获得701株病原菌,革兰阳性菌占52.1%,凝固酶阴性葡萄球菌占首位,葡萄球菌属对苯唑西林的耐药率高,检出2株耐万古霉素肠球菌;革兰阴性菌占34.5%,大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌分别占15.1%、4.6%、2.7%,其中60.4%大肠埃希菌和36.8%肺炎克雷伯菌ESBLs阳性,两者均对亚胺培南、美罗培南、哌拉西林/他唑巴坦敏感性高;真菌占13.4%,以热带假丝酵母菌、近平滑假丝酵母菌、白色假丝酵母菌为主,对抗真菌药物敏感率均较高,其中ICU患者占分离真菌菌株的37.6%。结论 5年血流感染呈逐年上升趋势,病原菌种属多样化,耐药率高;临床应加强对血培养中病原菌及耐药性的监测。

OBJECTIVE To analyze the distribution and drug resistance of pathogens from bloodstream infection, and provide a basis for clinical anti-infection treatment. METHODS A retrospective analysis of pathogenic bacteria＇s distribution and drug resistance from clinical blood specimens between Jan 2004 and Dec 2009 was performed. RESULTS A total of 701 pathogenic microorganisms were isolated from 7153 blood specimens, Gram-positive cocci, Gram-negative bacilli and fungi accounted for 52.10%, 34.5% and 13.4%, respectively. Coagulase-negative staphylococci （CNS） were the most common pathogens. The resistant rates of staphylococci to oxacillin were high, 2 strains of Enterococcus resistant to vancomycin were detected. Among the Gram-negative bacilli, the isolated rate of Escherichia coli was 15. 1%, Pseudomonas aeruginosa 4. 6%, Klebsiella pneumonia 2. 7%. 60.4% of Escherichia coli and 36. 8% of Klebsiella pneumonia produced ESBLs, and they were sensitive to imipenem, meropenem, piperacillin-tazobactam. Candida tropicalis, candida parapsilosis and candida albicans were the main fungi pathogens, they were sensitive to antifungal agents. 37.6% fungi were isolated from the patients in ICU. CONCLUSION Blood culture has been on the rise during these years, the species form are diversified, and the rate of the drug resistance is high. More attention should be paid to the detection of pathogens and drug resistance in blood culture.