医院感染败血症中革兰阴性杆菌的分布及耐药性分析

Analysis of distribution and drug resistance of gram-negative bacteria in hospital acquired septicemia

目的了解医院感染败血症中革兰阴性杆菌分布情况及耐药状况,探讨引起菌血症的相关因素,为临床合理应用抗菌药物提供科学依据。方法采用美国BD公司BACTEC 9120全自动血培养仪对10 910份标本进行培养检测,分离出的革兰阴性杆菌用法国梅里埃公司Vitek-2compact全自动微生物鉴定系统进行鉴定,数据使用WHONET5.6软件进行分析。结果 5年共检测出医院感染败血症中革兰阴性杆菌383株,株数呈逐年上升趋势。大肠埃希菌116株(30.3%),其中,产超广谱β-内酰胺酶(ESBLs)菌株78株,检出率为67.2%;肺炎克雷伯菌63株(16.4%),其中,产ESBLs菌株23株,检出率为35.9%;铜绿假单胞菌55株(14.4%);鲍曼不动杆菌28株(7.3%)。病原菌主要分布前5位的科室是血液病科、重症医学科、老年病科、泌尿外科和移植病房。碳氢酶烯类抗菌药物对大肠埃希菌和肺炎克雷伯菌的耐药率小于6.5%,喹诺酮类抗菌药物对铜绿假单胞菌敏感性较高,鲍曼不动杆菌对头孢哌酮/舒巴坦的耐药率最低(16.1%)。结论引起医院感染败血症的革兰阴性杆菌多发生在免疫力低下、年龄大及有插管介入诊疗的人群中,临床医生对此类患者应及时进行血液培养并合理用药,减少耐药株的产生。

Objective To understand gram-negative bacteria distribution and antibiotic resistance of pathogenic bacterium from hospital acquired septicemia and to explore the related factors causing septicemia and to provide the scientific basis for the clinical rational use of antimicrobial agents. Methods The 10 910 blood cultures were detected by BD BACTEC 9120 automated blood cul- ture system. Merieux Vitek-2 compact automated microbial identification system was used to identify gram-negative bacteria. WHO- NEt 5.6 software was applied for analysis of the bacterial sensitive date. Results A total of 383 strains of pathogenic bacteria were collected from hospital acquired septicemia in 5 years, the number was increasing year by year. The higher strains were Escherichia coli, Klebsiella pneumonia, Pseudomonas aeruginosa, and Acinetobacter baumannii, the isolating dates were 116 （ 30. 3 %）, 63 （16.4 % ）, 55 （14.4 % ） and 28 （7.3 % ）, respectively. The positive rates of ESBLs-producing Escherichia coli and Klebsiella pneumo- nia were 67.2 % and 35. 9 %, respectively. The pathogenic bacteria with a mainly distribution in hematological department, ICU, geriatrics department,urinary surgery and transplantating ward. The drug resistance rate of Escherichia coli and Klebsiella. pneu- moniae to carbapenems remained lower than 6.5 % % Pseudomnas aeruginosa was highly susceptible to quinolones. The drug resist- ance rate of Acinetobacter baumannii to cefoperazone/sulbactam remained the lowest （16.1%）. Conclusion Hospital acquired sep- ticemia caused by gram-negative bacteria occurred among people who immuno-compromised, the older and interventional catheteriza- tion. Clinicians should do blood culture timely to the patients and use drugs reasonably to reduce the drug resistant strains.