某县级医院连续4年血培养分离病原体及其耐药性

Distribution and antimicrobial resistance of pathogens isolated from blood culture in four consecutive years at a county-level hospital

目的了解某县级医院送检血培养标本分离的病原体分布及其耐药性。方法对该院2008—2011年收集的血培养标本分离的病原体资料进行回顾性分析。结果 4年1 780份血培养标本共分离病原体285株,阳性率为16.01%。其中革兰阳性(G+)球菌155株(54.39%),以金黄色葡萄球菌(84株,29.48%)和凝固酶阴性葡萄球菌(38株,12.28%)分离率较高;革兰阴性(G-)杆菌103株(36.14%),以大肠埃希菌(43株,15.09%)、铜绿假单胞菌(19株,6.67%)和肺炎克雷伯菌(13株,4.56%)分离率较高;真菌27株(9.47%),以白假丝酵母菌分离率(13株,4.56%)较高。G+球菌耐药率较高,但所有菌株对万古霉素和替考拉宁敏感;金黄色葡萄球菌中,耐甲氧西林株占40.48%,凝固酶阴性葡萄球菌中,耐甲氧西林株占57.14%。G-杆菌对亚胺培南、美罗培南及含酶抑制剂的抗菌药物较敏感;共检出产超广谱β-内酰胺酶菌31株,其中大肠埃希菌25株(58.14%),肺炎克雷伯菌6株(46.15%)。结论该县级医院血培养分离病原体以G+菌为主,耐药性较高,临床医生应根据药敏试验结果合理用药,以减轻抗菌药物的选择性压力。

Objective To investigate the distribution and antimicrobial resistance of pathogens isolated from blood culture from a hospital. Methods Data of pathogens isolated from blood specimens between 2008 and 2011 were an alyzed retrospectively. Results A total of 285 pathogenic isolates were obtained from 1 780 specimens, positive rate was 16. （11 %. The number of gram-positive cocci were 155 isolates（54. 39 % ）, the major were Staphylococcus aureus （84 isolates, 29. 48 % ） and coagulase negative Staphylococcus （38 isolates, 12. 28 %） ; the number of gram-negative bacilli were 103 isolates（36. 14% ）, the major were Escherichia coli （43 isolates, 15.09 % ）, Pseudomonas aeruginosa （19 isolates, 6. 67%）, and Klebsiella pneumoniae （13 isolates, 4. 56%）; the number of fungi was 27 isolates （9. 47% ）, the major was Candida albicans （13 isolates, 4. 56%）. The resistant rate of gram-positive cocci was high, but all strains were sensitive to vancomycin and teicoplanin, 40. 48% of Staphylococcus aureus and 57. 14% of co agulase negative Staphylococcus were methicillin-resistant. Gram-negative bacilli were sensitive to imipenem, mero penem,and enzyme inhibitor-containing antimicrobial drugs; 31 extended-spectrum β-lactamase-producing isolates were detected, 25 （58. 14% ） of which were Escherichia coli, 6 （46. 15 % ） were Klebsiella pneumoniae. Conclusion The major pathogens isolated from blood culture from this hospital are gram-positive bacteria, and antimicrobial re sistance is high, clinicians should choose antimicrobial agents according to antimicrobial susceptibility testing re sults, so as to reduce the emergence of resistant strains.