血培养标本中大肠埃希菌的耐药性及其分布

Drug resistance and distribution of Escherichia coli in blood culture samples

目的了解本院血培养标本中检出的常见革兰阴性杆菌——大肠埃希菌的耐药性及其标本来源,为临床治疗及控制院内感染提供依据。方法对2011年7月至2012年3月血培养标本中分离出的48株大肠埃希菌的耐药性及其标本来源进行回顾性分析。结果血培养中分离出的48株大肠埃希菌中,对亚胺培南、美罗培南、厄他培南、哌拉西林/他唑巴坦、头孢西丁、阿米卡星、阿莫西林/棒酸、头孢他啶、头孢吡肟、氨曲南、庆大霉素、左氧氟沙星、复方新诺明、头孢噻肟、环丙沙星、头孢唑啉和氨苄西林的耐药率分别为2.1%(1/48)、2.1%(1/48)、2.1%(1/48)、4.2%(2/48)、12.5%(6/48)、20.8%(10/48)、29.2%(14/48)、43.8%(21/48)、60.4%(29/48)、60.4%(29/48)、60.4%(29/48)、68.8%(33/48)、70.8%(34/48)、73%(35/48)、75%(36/48)、79.2%(38/48)和87.5%(42/48)。所检出大肠埃希菌位居前7位的科室分别为消化内科(12/48,25%)、ICU(6/48,12.5%)、内分泌科(5/48,10.4%)、心血管内科(5/48,10.4%)、儿内科(3/48,6.3%)、泌尿外科(3/48,6.3%)和血液内科(3/48,6.3%)。结论血培养中已检出对碳青霉烯类抗菌药物耐药的大肠埃希菌,医院应提高血标本的送检率,根据药敏结果选用抗菌药物。

Objective Escherichia coli was the most common Gram-negative bacteria detected from blood culture in our hospital. The present study was aimed to provide evidence for clinical treatment and control of nosocomial infections according to the drug resistance and distribution. Methods The drug resistance and sample source of 48 Escherichia coli isolated from cultured blood samples in July 2011 to March 2012 were analyzed, retrospectively. Results Drug-resistance of these Escherichia coli to imipenem, meropenem, ertapenem, piperacillin-tazobactam, cefoxitin, amikacin, ampxillin/clavalavic acid, ceftazidime, cefepime, aztreonam, gentamycin, levofloxacin, sulfamethoxazole compound, cefotaxime, ciprofloxacin, cefazolin and ampicillin were 2.1% （1/48）, 2.1% （1/48）, 2.1% （1/48）, 4.2% （2/48）, 12.5% （6/48）, 20.8% （10/48）, 29.2% （14/48）, 43.8% （21/48）, 60.4% （29/48）, 60.4% （29/48）, 60.4% （29/48）, 68.8%（33/48）, 70.8% （34/48）, 73% （35/48）, 75% （36/48）, 79.2% （38/48） and 87.5% （42/48）, respectively. The top seven wards with isolation of Escherichia coli were department of gastroenterology （12/48, 25%）, intensive care unit （6/48, 12.5%）, department of endocrinology （5/48, 10.4%）, cardiovascular internal medicine （5/48, 10.4%）, pediatrics （3/48, 6.3%）, department of urinary surgery （3/48, 6.3%） and hematological departments （3/48, 6.3%）. Conclusions Carbapenem resistant Escherichia coli has been detected in blood culture, the bacterial examination rate should be improved, and the optimal antibiotic should be chosen on the basis of drug sensitivity results.