2008-2010年血培养细菌分布与耐药性变迁

Distribution of blood cultured bacteria in 2008-2010 and changes in their drug resistance

目的了解我院2008-2010年血培养细菌的菌种分布、科室分布及耐药变迁特点,为临床合理使用抗生素提供依据。方法患者血液培养标本经BACTEC9050血培养仪培养,分离所得菌株用美国德灵公司Microscan-walkaway96全自动微生物鉴定仪进行菌株鉴定和药敏实验。结果连续三年凝固酶阴性葡萄球菌分离率居首位,大肠埃希氏菌居第二位,肺炎克雷伯菌、金黄色葡萄球菌、鲍曼/溶血不动杆菌、铜绿假单胞菌是导致血液感染的主要病原菌;大肠埃希氏菌和肺炎克雷伯菌对亚胺培南100%敏感,对哌拉西林/他唑巴坦、阿米卡星较敏感,但对两药耐药率呈逐年上升趋势;各类抗菌药物对鲍曼不动杆菌和铜绿假单胞菌耐药率较高,呈逐年上升趋势,且出现泛耐药菌株;血培养阳性球菌中未发现耐万古霉素和利奈唑胺的金黄色葡萄球菌、凝固酶阴性葡萄球菌和肠球菌。结论血液培养的细菌种类多样,且分离率居前几位细菌的耐药率较高。临床和实验室应加强血流感染细菌的耐药性监测。

Objective To provide the evidence for rational use of antibiotics in clinical practice by investigating the distribution of blood cultured bacteria in 2008-2010 and changes in their drug resistance.Methods Bacteria isolated from blood samples were cultured with BACTEK 9050 and identified with Microscan walkaway-96 and then underwent drug sensitivity test.Results The rate of isolated coagulase negative staphylococci（CNS） was the highest followed by Escherichia coli（E.coli）.Klebsiella pneumoniae（K.pneumoniae）,staphylococcus aureus（S.aureus）,Bowwan/hemolytic amotile bacteria,and Pseudomonas aeruginosa were the main pathogens leading to blood infection.The sensitivity of E.coli and K.pneumoniae to imipenem was 100% and rather high to amikacin and pipracillin-tazobatan.The sensitivity of Bowwan/hemolytic amotile bacteria and Pseudomonas aeruginosa to different antibiotics was also rather high.No S.aureus,CNS and enterococci were found to be sensitive to vancomycin and linezolid.Conclusion Different bacteria can be isolated from blood cultured samples and have a rather high drug resistance.More attention should be paid to the drug resistance of blood infection bacteria both in clinical practice and in laboratory.