604株血培养致病菌的分布及耐药性分析

Distribution and drug sensitivity test of pathogens in 604 blood cultures

目的了解本院2009年7月至2012年6月血培养致病菌分布情况与主要致病菌的耐药特点。方法采用ATB系统鉴定细菌,Kirby-Bauer琼脂扩散法作体外药敏试验,应用WHONET5.5软件分析药敏结果。结果培养鉴定临床致病菌共604株,其中革兰阳性菌340株(55.16%),革兰阴性菌253株(42.55%),真菌11株(1.82%);药敏结果显示:葡萄球菌中耐甲氧西林金黄色葡萄球菌(MRSA)对各类常用抗菌药物耐药性均高于甲氧西林敏感金黄色葡萄球菌(MSSA)及甲氧西林敏感凝固酶阴性葡萄球(MSCNS),MRSA和耐甲氧西林凝固酶阴性葡萄球(MRCNS)的检出率分别为39%及82.4%;40%以上的肠球菌对高浓度的庆大霉素耐药,未发现耐万古霉素的葡萄球菌和肠球菌;对大肠埃希菌和肺炎克雷伯菌,碳青霉烯类、含酶抑制剂的β-内酰胺类和阿米卡星保持较高的敏感性。结论及时监测血培养中病原菌的耐药性对指导临床合理用药、提高治愈率、防止滥用抗菌药物及减少耐药菌株的产生具有重要意义。

Objective To comprehend the distribution of pathogens and the main pathogenic bacteria resistant characteristics in blood culture in July 2009 to June 2012 in our hospital and to provide a reference basis for clinical therapy.Methods Microorganisms were identified by ATB System and Kirby Bauer agar diffusion test was used for the antibiotics susceptibility test.The distribution and antimicrobial susceptibility test results of pathogens isolated from the blood culture were analyzed based on WHONET5.5 software.Results 604 strains microorganisms were isolated,of which Gram positive bacteria were 340 （55.16%）,Gram negative bacteria were 253 （42.55%） and fungi were 11 （1.82%）.The main pathogenic bacteria that caused bacteremia or sepsis were Escherichia coli,staphylococcus epidermidis,staphylococcus aureus.Top three pathogenic bacteria were ICU,Pediatrics and Respiratory Medicine.Antimicrobial susceptibility test results show：The detection rates of MRSA and MRCNS were 39% and 82.4%,and their drug resistance to all kind of antibiotics were higher than MSSA and MSCNS;more than 40% of Enterococcus were drug-resistant to a high level of gentamicin,and staphylococcus or enterococcus was not found with vancomycin drug-resistant.Conclusion The microorganisms isolated from blood culture were widely distributed and resistant to antibiotics.Monitoring and analyzing the strains isolated from blood culture and their resistance timely were very important in helping guiding clinical medication in principle,enhancing the curative rate,preventing abuse of antibiotics and reducing the generation of drug-resistant strains.