2009至2012年血培养阳性结果分析及耐药性监测

Positive Results Analyses & Resistance Monitoring in Blood Culture Specimens from 2009 to 2012

了解解放军202医院2009至2012年血培养阳性病原菌分布及耐药性监测,为临床合理选用抗菌药物提供依据。使用全自动血培养仪进行血液培养,用VITEK-2全自动微生物鉴定系统进行菌株鉴定和药敏试验。从453例血培养阳性标本中共分离出462株病原菌,其中革兰阴性杆菌274株,占59.30%;革兰阳性球菌167株,占36.14%;革兰阳性杆菌1株,占0.22%;真菌20株,占4.32%。最常见的感染菌分别为金黄色葡萄球菌、大肠埃希菌、肺炎克雷伯菌、凝固酶阴性葡萄球菌。89株金黄色葡萄球菌中检出MRSA 9株,46株凝固酶阴性葡萄球菌中检出MRCoN 6株,对青霉素耐药率分别达81.35%和85.00%,革兰阳性球菌中未发现对利奈唑胺和万古霉素耐药的菌株。鲍曼不动杆菌对美罗培南耐药率高达51.7%。解放军202医院血液感染以葡萄球菌和大肠埃希菌为主,且耐药率高,应对血液细菌进行长期的耐药性监测,为临床合理使用抗生素提供理论依据。

In order to provide clinical evidences for rational use of antimicrobial medicines, the distribution and drug resistance of positive pathogens in blood culture specimens in PLA 202 Hospital from 2009 to 2012 was tested and de- termined. Full automatic blood culture instrument and VITEK-2 full automatic microbe characterization system was used to characterize the bacteria and perform the drug susceptibility test. The results showed that 462 strains were iso- lated from 453 blood culture positive samples, among them 274 strains were Gram-negative bacilli accounted for 59.30% ; 167 strains were Gram-positive cocci accounted for 36.14% ; 1 strains was Gram-negative bacillus accoun- ted for 0.22% ; 22 strains were fungi accounted for 4.32%. The most common infectious bacteria were Staphylococcus aureus, E. coll, Klebsiella pneumoniae, and Staphylococcus epldermidis. 9 MRSA strains were detected from 89 S. aureus strains; while 6 MRCoN strains were detected from 46 coagnlase-negative staphylococci, whose resistance rate to penicillin were 81.35% and 85.00%. However, the linezolid and vancomycin resistant strains were not found in Gram-positive cocci. Acinetobacter baumannii resistance rate to meropenem was as high as 51.7%. Therefore, E. coli and Staphylococcus were the main pathogens in the hospital with high resistant rate. And long term monitoring of drug resistance in blood bacteria should be detected in response to provide a theoretical basis for clinical use of antibiotics.