海南省人民医院2011年血培养病原菌分布和耐药性分析

Analysis on Distribution and Drug Resistance of Pathogenic Bacteria Obtained from Blood Cultures in Hainan Provincial People's Hospital in 2011

目的了解本院血培养病原菌的分布及常见致病菌的耐药特点,为临床用药提供依据。方法采用手工方法将血液标本接种至增菌肉汤中,有生长迹象时接种平板,用迪尔DL-96系统进行细菌鉴定及药敏分析。结果 10 800份临床标本中分离出病原菌381株(按每个病人分离的第一株菌计算)。其中,革兰阳性菌161株(42.26%),革兰阴性菌169株(44.35%),真菌51株(13.39%)。检出病原菌数前五位的科室依次是重症医学科71株、儿科64株、新生儿科38株、呼吸内科28株、急诊病房22株。革兰阳性菌仅对万古霉素、利奈唑胺、替考拉宁敏感率较高,肠杆菌科细菌仅对亚胺培南和美罗培南、阿米卡星有较高的敏感性,另发现一株肺炎克雷伯菌(ESBL阴性)对这两种药耐药,铜绿假单胞菌对抗生素有较高的敏感性。结论血培养病原菌以条件致病菌为主,且耐药问题严重,及时监测病原菌变化及耐药趋势以指导临床用药至关重要。

Objective To investigate the distribution and drug resistance characteristics of pathogenic bacteria isolated from blood cultures in Hainan Provincial People＇s Hospital, and to provide the direct evidence for clinical medication. Methods The blood samples were inoculated in the biphasic blood culture broth with manual method and then inoculated to the flat after visible growth. Deere DL- 96 system was used to identify the stains and analyze the drug sensitivity. ~ Results Altogether 381 strains of pathogenic bacteria （only accounted the first strain isolated from each patient） were isolated from 10,800 clinical specimens, among them gram- positive bacteria were 161 （42.26%）, gram- negative bacteria were 169 （44.35%）, and fungi were 51 （13.39%）. The top five departments that had the isolated strains were ICU with 71 isolates, pediatrics with 64 iso- lates, neonatology department with 38 isolates, respiratory department with 28 isolates and emergency ward with 22 isolates. Gram - positive bacteria only had high sensitivity to vancomycin, linezolid and teicoplanin. Enterobacteriaccae was only sensitive to imipenem, meropenem and amikacin, while one strain of Klebsiella pneumoniae （ESBL negative） was found to be resistant to imipenen and meropenem. Pseudomonas aerug/nosa had high sensitivity to all the drugs tested. Conclusions Most of patho- gens isolated from blood cultures are opportunistic bacteria, and the drug resistance problem is serious. Timely monitoring the changes of pathogenic bacteria and drug resistance trend is essential for guiding clinical medication.