2009—2012年某院血培养病原菌分布与耐药性变迁

Distribution and Drug Resistance Changes of Blood Culture Pathogens in Hospital,2009-2012

目的了解内蒙古自治区人民医院2009—2012年血培养阳性标本的病原菌分布和耐药性变迁。方法采用Bact/Alert 3D全自动血培养仪,对血培养培养瓶进行连续培养监测,细菌鉴定和药敏试验采用法国生物梅里埃公司VITEK 2-compact全自动微生物分析系统,应用Whonet5.6软件对数据进行统计分析。结果 2009—2012年,该院共分离出659株病原菌,阳性率为13.9%。其中,革兰阴性杆菌和革兰阳性球菌所占比例分别为54.5%、42.9%。大肠埃希菌检出率最高,占25.6%,其次是凝固酶阴性葡萄球菌(人葡萄球菌和表皮葡萄球菌),占23.9%。血培养阳性菌多见于泌尿内科(占12.3%)、ICU(占12.5%)、普外科(占11.2%)。耐药性分析显示:血行感染肠杆菌科细菌对亚胺培南高度敏感(100.0%),其对头孢替坦、哌拉西林/他唑巴坦和阿米卡星也较敏感(>85.7%)。未发现耐万古霉素的葡萄球菌和肠球菌,利奈唑胺和奎奴普丁/达福普丁也对革兰阳性球菌有较好的敏感性(>93.1%)。铜绿假单胞菌和不动杆菌对多种抗菌药物的耐药率比较高,只有阿米卡星、哌拉西林/他唑巴坦、氨苄西林/舒巴坦、环丙沙星和左旋氧氟沙星耐药率较低(<17.1%)。结论血培养病原菌分布和耐药性变迁有其特点,可为其治疗及预防提供依据。

Objective To investigate the distribution and drug resistance changes of blood culture pathogens in Inner Mongolian People’s Hospital between 2009 and 2012.Methods Blood samples were cultured with the BacT/Alert 3D automated blood culture system.Bacterial identification and antibiotic susceptibility testing were performed using Vitek 2 system（bio-Merieux, France）.All data were analyzed using Whonet 5.6 software.Results A total of 659 strains of pathogens were isolated from blood samples between 2009 and 2012.The positive rate was 13.9%.Of the 659 strains,gram-negative bacilli and gram-positive cocci accounted for 54.5% and 42.9%,respectively.The detection rate was highest in Escherichia coli（25.6%）,followed by coagulase-negative staphylococcus（Staphylococcus aureus and staphylococcus epidermidis,23.9%）. The positive blood culture pathogens were commonly found in department of urology（12.3%）, ICU（12.5%） and department of general surgery （11.2%）.Antibiotic susceptibility testing showed that Enterobacteriaceae strains were highly susceptible to carbapenem （100.0%）,and were also sensitive to cefotetan,piperacillin/tazobactam and amikacin（〉85.7%）.No strains re-sistant to vancomycin were found in Staphylococcus and Enterococcus isolates.Linezolid and quinu-pristin/dalfopristin exhibited high activity against grampositive cocci（〉93.1%）.Pseudomonas aeruginosa and Acinetobacter were highly resistant to multiple antimicrobial agents,except for amikacin,piperacillin/tazobactam,ampicillin/sulbactam,ciprofloxacin and levofloxacin（〈17.1%）.Conclusion The distribution and drug resistance changes of blood culture pathogens have their own characterristics,which can provide the basis for the treatment and prevention of diseases.