某三甲医院2010年血培养标本中细菌分布及耐药分析

Distribution and Drug Resistance of Pathogens Isolated from Blood Cultures in 2010 from a Certain 3A Hospital

目的监测和分析本院2010年血培养标本中分离病原菌的种类、分布及耐药状况,指导临床合理运用抗菌药物。方法采用BACT/ALERT3D全自动血培养仪对血培养标本进行检测,阳性标本分离菌株使用VITEK2Compact进行细菌鉴定及药敏分析。结果 6 742例血培养标本中共分离出331株病原菌,阳性率为4.91%,其中革兰阳性球菌174株,占52.6%;革兰阴性杆菌142株,占42.9%;真菌16株,占4.8%;主要病原菌依次为凝固酶阴性葡萄球菌、大肠埃希菌、肺炎克雷伯菌、链球菌、肠球菌,分离率分别为27.5%、21.1%、7.6%、7.6%、7.3%。葡萄球菌中MRSA和MRCNS的检出率分别为33.3%、91.1%,对万古霉素、米诺环素、利福平的敏感性较高;大肠埃希菌和肺炎克雷伯菌中ESBLs的检出率分别为65.7%、52.0%,对美洛培南、亚胺培南、阿米卡星的敏感性较高。结论本院血流感染病原菌种类复杂多样、耐药程度严重,需及时监测病原菌的菌群种类、分布和耐药变迁,以指导临床合理、规范地使用抗菌药物。

Objective To investigate the distribution and drug resistance of pathogens isolated from blood cultures in 2010, and to provide an optimal antimicrobial therapy. Methods Blood samples were cultivated with BACT/ALERT 3D automated blood culture system, bacterial confirmatory and antibiotic susceptibility tests were carried out with VITEK 2 Compact bacterial identification system. Results A total of 331 strains of pathogenic bacteria were isolated from 6 742 blood cultures, including 174 （52.6%） strains of gram positive cocci, 142 （42.9%） strains of gram negative bacilli and 16 （4.8%） strains of fungi. The leading pathogens were CNS, E. coli, Klebsiella, Streptococcus and Enterococeus, account- ing for 27. 5%, 21.1%, 7. 6%,7.6%, 7.3% respectively. The rates of MRSA and MRCNS in Staphylococcus were 33.3% and 91.1%, and the strains were sensitive to vancomycin,minocycline,rifampicin. The detectable rates of E. coli, Kleb- siella of ESBLs were 65.7% and 52.0%, and the strains were sensitive to imipenem, meropenem and amikacin. Conclusion It is diversiform and seriously resistant in nosocomial bloodstream infections,thus,we should enhance the drug resistance monitoring and select an optimal antimierobial therapy.