某院2008至2011年血流感染病原菌的临床分布特征及耐药性分析

Evaluation of The Clinical Distribution Characteristics and Antimicrobial Susceptibility Patterns of Bacteria from Bloodstream Infections in Maoming People's Hospital from 2008 to 2011

目的了解引起血流感染病原菌的临床分布特征及耐药性,为指导临床合理用药提供依据。方法用BacT/ALERT 3D微生物全自动检测系统对血标本进行培养检测,用VITEK-2全自动微生物鉴定仪对病原菌进行鉴定及药物敏感性检测,WHONET5.4软件进行数据的统计及分析。结果 2008至2011年共收检血培养标本10462份,检出病原菌966株,阳性率为9.23%。其中革兰阴性杆菌442株,占53.3%,以大肠埃希菌为主,占33.7%;革兰阳性球菌275株,占33.2%,以凝固酶阴性葡萄球菌(CoNS)为主,占44.4%;真菌112株,占13.6%。引起血流感染的病原菌中,大肠埃希菌居首位(18.0%),其次为凝固酶阴性葡萄球菌(CoNS)14.7%、肺炎克雷伯菌8.2%。产ESBLs大肠埃希菌和肺炎克雷伯菌分别为67.5%和49.1%,MRSA和MRCoNS的检出率分别为53.2%和88.5%,未发现耐万古霉素革兰阳性球菌。临床科室分布以ICU、儿科和血液科为主,分别为25.5%、22.2%和12.4%。血流感染患者基础疾病以恶性实体肿瘤、血液病多见,分别为26.8%、20.6%。结论及时了解血培养结果可以对临床抗菌治疗提供依据,提高治愈率,对控制医院血流感染具有重要意义。

Objectives To identify the spectrum of pathogens causing bloodstream infection in epidemiology and antibiotic resistance patterns.Methods BacT/ALERT 3D Automated Microbial Detection System was used to for the detection of blood preparation.VITEK-2 Compact Automated Microbiology System was performed for identification of pathogenic bacteria and drug susceptibility patterns.Statistical analysis was performed with WHONET5.4.Results 10462 blood cultures were examined in this investigation from 2008 to 2011,a total of 966 strains were isolated,positive rate 9.23%.Gram-positive bacteria comprised 33.2% and Gram-negative bacteria comprised 53.3% and fungi comprised 13.6%.Moreover,the diversity of Escherichia coli comprised 18.0%,followed by Coagulase-negative staphylococci（14.7%） and Klebsiella Pneumoniae（8.2%）.The ESBLs positive rates of Escherichia coli and Klebsiella Pneumoniae were 67.5% and 49.1%.The rates of Oxacillin resistance for S.aureus and Coagulase-negative staphylococci isolates were 53.2% and 88.5%,respectively.Vancomycin resistant S.aureus and Coagulase-negative staphylococci strains were not detected.The dominant departments for infection was ICU（25.5%）,department of paediatrics（22.2%） and department of hematology（12.4%）.Moreover,bloodstream infections were more frequent in patients with malignancy（26.8%） and hematonosis（20.6%）.Conclusion Knowing the distribution of clinical pathogens and its drug fast tendency is helpful to adjust clinical treatment plan and discover drug-resistant strains.