2008—2012年血培养标本中病原菌分布及其耐药性分析

Distribution of pathogens isolated from blood culture specimens during 2008-2012 and their drug resistance analysis

目的了解2008—2012年广东省中西医结合医院血培养病原菌的分布及耐药性,为临床合理选用抗菌药物提供依据。方法回顾性分析2008年1月至2012年12月临床送检血培养标本所分离的病原菌及药敏试验结果。使用BacT/ALERT3D全自动血培养仪器、阳性标本转种血平板及巧克力平板、VITEK-32全自动微生物鉴定药敏系统进行鉴定和药敏试验,药敏结果用WHONET5.4软件进行统计分析。结果 4 294份血培养标本中共获得361株病原菌,革兰阳性球菌占37.95%(137/361),其中金黄色葡萄球菌数量占首位,对苯唑西林耐药率为55.71%;革兰阴性杆菌占62.05%(224/361),其中大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌分别占37.95%(137/361)、8.31%(30/361)、2.22%(8/361)。而在大肠埃希菌和肺炎克雷伯菌中超广谱β-内酰胺酶(ESBLs)阳性分别占51.72%、35.45%。结论大肠埃希菌是血液感染常见病原菌,且对头孢他啶、阿米卡星、头霉素类、β-内酰胺酶抑制剂、碳青霉烯类抗生素仍保持较高药物敏感性;万古霉素、替考拉宁、利奈唑胺对革兰阳性球菌均有效。造成血液感染的病原菌种属多样化,耐药率高,临床应加强对血培养中病原菌及耐药性的监测。

Objective To understand the distribution and drug resistance of pathogens isolated from blood culture sam- ples in this hospital from 2008 to 2012 to provide basis for rational use of antibacterial drugs. Methods The retrospective analy- sis was conducted on pathogenic bacteria isolated from the clinical blood culture samples and the results of drug sensitive test from January 2008 to Deeecmber 2012. The BaeT/ALERT3D fully automatic blood culture instrument was adopted for conducting blood culture. The positive samples were inoculated to the blood plate and the chocolate plate. The strains identification and the drug sensitivity test were performed by VITEK-32 fully automatic microbiological identification and drug sensitivity system. The results of the drug sensitivity test were analyzed by WHONETS.4 software. Results 361 pathogenic bacterial strains were isolated from 4 294 blood culture samples. Among them, Gram-positive cocci accounted for 37.95% （137/361 ）, Staphylococcus aureus accounted for the first place,and the resistance rate to oxacillin was 55.7% ;Gram-negative bacilli accounted for 62.05% （224/361）,Es- cheriehia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa accounted for 37.95 % （ 137/361 ）, 8.31% （ 30/361 ） and 2.22% （18/361 ） respectively, in which positive extended spectyum [3-1actamase （ESBLs） of Escherichia coli and Klebsiella pneumoniae accounted for 51.72% and 35.45% respectively. Conclusion Escherichia coil is the common pathogen of bloodstream infection and highly sensitive to ceftazidime ,amikaein ,cephamyeins ,beta-lactamase inhibitors and earbapenems ;vaneomyein ,teieoplanin and linezolid are effective to Gram-positive cocci. Pathogenic bacterial species are various with high drug-resistant rate. The moni- toring of pathogens and their drug-resistance in blood cuhure should be strengthened in clinic.