4211份血标本分离的病原菌分布及耐药性分析

Distribution and drug resistance of pathogens isolated from 4211 blood specimens

目的了解血培养标本的病原菌分布及其耐药性。方法病原菌培养采用法国生物梅里埃公司Bact/Alert 3D全自动血培养仪,药敏试验采用英国Oxoid公司药敏纸片扩散法和M-H琼脂培养基;用WHO-NET 5.4软件进行数据分析。结果 4211份血培养阳性率为16.12%;所分离出的679株非重复菌株中,革兰阳性菌占59.06%,革兰阴性菌占35.20%、真菌占5.74%;病原菌占首位的是凝固酶阴性葡萄球菌,占34.76%,其次是大肠埃希菌、金黄色葡萄球菌、肠球菌属、肺炎克雷伯菌和铜绿假单胞菌等;革兰阳性菌中除鹑鸡肠球菌、铅黄肠球菌对万古霉素天然耐药外,其他病原菌对其高度敏感,而对临床常用抗菌药的耐药率较高;革兰阴性菌对常用头孢菌素类和喹诺酮类抗菌药耐药率较高。结论病原菌耐药与抗菌药物的大量应用有关,为避免对病原菌过快产生耐药性而导致严重后果,临床医师应严格掌握用药指征,并根据药敏结果选药。

OBJECTIVE To investigate the distribution and antibiotic resistance of pathogenic bacteria isolated from the 4211 blood culture specimens collected from 2006 to 2010. METHODS The bacterial culture was performed with fullautomatic BACT/ ALERT 3D blood culture system of M6rieux （France） ; antibiotic susceptibility testing was carried out by the means of KirbyBauer method （Oxoid, Britain） and MH agar medium; statistical anaiysis was performed by using WHONET 5.4 software. RESULTS The positive rate of 4211 blood culture specimens was 16.12%. Among 679 strains of nonrepeating pathogens isolated, grampositive bacteria accounted for 59.06%, gramnegative bacteria accounted for 35.20%, and fungi accounted for 5.74%; the coagulasenegative Staphylo coccus rank the top, followed by Escherichia coli , S. aureus, Enterococcus, Klebsiella pneumoniae , and Pseudo monas aeruginosa. Grampositive bacteria except E . gallinarum and E. casselifavus were highly susceptible to vancomycin and highly resistant to common antibiotics; the resistance rates of gramnegative bacteria to cephslosporins and quinolones were relatively high. CONCLUSION The drug resistance is as,~ociated with the abuse of antibiotics. In order to avoid the serious consequences ied by high antibiotic resistance, the clinicians should strictly follow the indications and use antibiotics based on the results of drug susceptibility testing.