2007-2010年综合医院血培养病原菌分布及耐药性分析

Distribution and drug resistance of isolated bacteria from blood culture in general hospital from 2007 to 2010

目的了解2007-2010年医院血液培养病原菌的分布及耐药性,为临床合理选用抗菌药物提供依据。方法采用BacT/ALERT3D全自动血培养仪器,阳性标本转种血平板及巧克力平板,ATB Expression鉴定仪系统鉴定菌种及药敏试验,采用WHONET5.4软件对4741份血培养进行回顾性分析。结果检出病原菌613株,阳性率为12.93%,其中革兰阳性球菌368株,占60.03%,革兰阴性杆菌171株,占27.90%,真菌74株,占12.07%;葡萄球菌属对利奈唑胺、万古霉素、呋喃妥因敏感,耐药率为0,革兰阴性菌(除鲍氏不动杆菌)对碳青霉烯类药物敏感性较好,凝固酶阴性葡萄球菌中耐甲氧西林菌株占92.86%,金黄色葡萄球菌中耐甲氧西林菌株占61.54%,大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶检出率分别为22.50%、20.00%。结论血培养阳性标本检出病原菌主要是凝固酶阴性葡萄球菌,多种菌株耐药率高,临床予以重视。

OBJECTIVE To understand and investigate the distribution and drug resistance of pathogens cultured from blood from 2007 to 2010 so as to provide the clinical evidence for rational use of antimicrobial drugs. METHODS BacT/ALERT3D automated blood culture instrument was adopted, positive samples were transferred to blood agar and chocolate plates. Bacteria identification and susceptibility testing were performed with ATB expression instrument identification system. Totally 4741 copies of blood cultures were retrospectively analyzed with software WHONET 5.4. RESULTS Totally 613 pathogens were isolated with the positive rate of 12.93%, among which there were 368 strains （60. 030/oo） of gram-positive cocci, 171 strains （27.90%） of gram-negative bacilli, 74 strains （12.07%） of fungi. The drug resistance rates of Staphylococcus to l inezolid, vancomycin, and nitrofurantoin were 0. The susceptibility of gram-negative bacteria （ except for Acinetobacter baumannii ） to carbapenems was relatively high. Methicillin-resistant isolates accounted for 92. 86% among coagulase-negative Staphylococcus methicillin-resistant isolates accounted for 61. 54% among S. aureus. The detection rates of extended spectrum fl-lactamases-producing Escherichia coli and Klebsiella pneumoniae were 22.50 % and 20.00 % respectively. CONCLUSION The pathogens detected in positive blood cultures are mainly eoagulase-negative Staphylococci. The resistance rates of many strains are high, which should be highlighted.