5042份血培养细菌的耐药性监测分析

Monitoring and analysis of drug resistance of bacteria in 5042 blood samples

目的了解血液标本中细菌培养的结果及病原菌的耐药性，为临床血液感染的诊断、治疗提供依据。方法分析2009—2012年我院送检的5042份血液标本中检出671株细菌的病原菌特性及其耐药性。血液培养采用BacTALERT3D全自动快速微生物培养侦测系统，细菌鉴定和药物敏感试验（MIC法）采用VITEK2Compact全自动细菌培养鉴定仪。结果血液标本中阳性细菌检出率为13．3％（671／5042），其中革兰阴性杆菌占49．9％（335／671），革兰阳性球菌占40．8％（274／671）；分离数前5位的细菌为大肠埃希菌、人葡萄球菌、表皮葡萄球菌、肺炎克雷伯菌和金黄色葡萄球菌；2009—2012年间病原菌的分离增长比例分别为30．5％（29／95）、44．4％（55／124）和52．5％（94／179）；病区来源主要为肾内科[12．1％（81／671）]、普外科[11．6％（78／671）]和ICU病房[10．6％（71／671）]；普外科的分离率由2009年的第五位上升到2012年的第一位，呼吸内科的分离率由2009年的第三位降低到2012年的第十位。亚胺培南、哌拉西彬他唑巴坦、头孢替坦、头孢他啶对大肠埃希菌和肺炎克雷伯菌的耐药率均〈9．7％；利奈唑胺、万古霉素、替考拉宁、奎奴普丁／达福普汀和呋喃妥因对人葡萄球菌、表皮葡萄球菌和金黄色葡萄球菌的耐药率均〈2．3％。结论病原菌的分布、病区来源和耐药性会发生变化，实验室应加强血液感染细菌的耐药性监测，指导临床合理应用抗生素。

Objective To investigate the drug resistance of patients samples in terms of pathogenic bacteria in order to provide the basis for clinical diagnosis, treatment of blood infection. Methods Six hundred and seventy-one bacteria strains out of 5042 blood samples of hospitalized patients were used to analyze its characters and drug resistance from January 2009 to December 2012 in the people＇s hospital of inner mongolia autonomous region. BacT ALERT 3D automatic rapid microbial detection system was applied to perform blood culture. The bacteria identification and drug sensitivity test （MIC method） were detected by using VITEK 2 Compact automatic bacteria identification instrument. Results Bacteria positive rate was 13.3% （671/5042）, of which the gram negative bacilli accounted for 49.9% （335/671） ,and gram positive for 40. 8% （274/671）. The top 5 bacteria strains of blood samples were escherichia coli, staphylococcus, staphylococcus aureus, klebsiella pneumoniae and staphylococcus aureus. The pathogenic bacteria rates of blood samples were 30. 5% （29/95） ,44.4% （55/124） and 52. 5% （94/179） respectively during 2009 -2012. The main source of blood bacteria renal were department of internal medicine ward （12.1% ,81/671 ） , department of general surgery （11.6% ,78/671 ）, and ICU ward （10. 6% ,71/671 ）. The detected bacteria rate in department of general surgery separation rate increased to the first in 2012 from fifth in 2009. However the detected bacteria rate in department of internal medicine was down to the tenth in 2012 from the third in 2009. The drug resistancd rate of imipencm, piperacillin/tazobactam, cefotaxime, ceftazidime resistant cefotetan on escherichia coli and klehsiella pneumoniae were all less than 9. 7% , and the rate of linezolid, vancomycin, teicoplanin, quinupristin/dafoe leptin and nitrofurantoin resistance of staphylococcus aureus, staphylococcus bacteria and gold staphylococcus aureus were all less than 2. 3%. Conclusion The distribution, sources and drug resistance of pathogenic bacteria had been changed recently. Therefore the laboratory shall strengthen the monitoring of drug resistance of bacteria in the bloodstream infection in order to guide clinical rational application of antibiotics.