1368份血培养的病原菌分布及耐药性分析

Distribution and drug resistance of pathogens isolated from 1368 blood culture specimens

目的了解血培养阳性致病菌菌谱以及药敏情况,为抗菌药物合理使用提供理论依据。方法采用美国BD公司BACTEC9050型全自动血培养仪及其配套培养瓶,所有菌株按照常规操作流程进行鉴定,药敏试验采用K-B纸片扩散法,细菌菌谱及耐药性分析用WHONET5.5软件。结果 1368例血液培养标本中共分离出29种119株病原菌,检出率为8.7%;其中革兰阳性球菌63株,占52.9%,革兰阴性杆菌51株,占42.9%,真菌4株,占3.3%,革兰阳性杆菌1株,占0.8%;葡萄球菌属、链球菌属、肠球菌属耐药率各异,但均未发现万古霉素耐药菌株;革兰阴性杆菌中,各菌属对抗菌药物均有一定的耐药率;但均未发现亚胺培南和美罗培南耐药株;白色假丝酵母菌对多数抗真菌药物有一定程度的耐药,但耐药率均<25.0%,仅对两性霉素B 100.0%敏感。结论血液培养病原菌菌谱较广,以革兰阳性球菌为主,革兰阴性杆菌次之,且耐药情况普遍存在,因此应及时对血液细菌进行耐药性监测并指导临床合理使用抗菌药物。

OBJECTIVE To investigate the distribution and drug resistance of pathogens from blood infection samples,so as to provide evidence for rational use of antibiotics in clinic.METHODS BACTEC9050 automated blood culture system manufactured by American BD Company and its corresponding adult aerobic resin bottles were used.All pathogens were identified in accordance with routine operating procedures.Drug susceptibility test was performed by K-B diffusion method and the results were analyzed by WHONET 5.5 software.RESULTS Totally 119 strains of 29 species of pathogens were isolated from 1368 blood culture samples,with the positive rate of 8.7%.Among these pathogens,63 isolates（52.9%） were gram-positive cocci,51 isolates（42.9%） were Gram-negative bacilli,4 isolates（3.3%） were fungi,1 isolate（0.8%） was gram-positive bacilli.Drug resistance rates of Staphylococcus,Streptococcus and Enterococcus were different,but there were no vancomycin-resistant strains detected.The species of gram-negative bacilli had certain degree of resistance to antibiotics,but no strains resistant to imipenem（IPM） or meropenem（MEM）were found;Candida albicans was resistant to most antifungal agents,but all the resistance rate was less than 25.0%,while the isolates were 100.0% sensitive to amphotericin B.CONCLUSION The spectrum of blood culture pathogens is wide,and the predominant pathogens are gram-positive cocci,followed by gram-negative bacilli.The drug resistance is prevalent,so the monitoring of drug resistance of blood culture pathogens should be carried out in a timely manner to guide rational use of antibiotics.