医院获得性血流感染患者病原菌分布及耐药性分析

Distribution and drug resistance of pathogenic bacteria in patients with nosocomial bloodstream infections

目的研究医院获得性血流感染病原菌分布及其耐药性,旨在为临床用药提供参考依据。方法选取2009年1月-2012年10月确诊的医院获得性血流感染患者383例,采取回顾性分析的方法对病原菌培养结果及药敏试验结果进行统计。结果 383例患者中共检出病原菌436株,其中革兰阴性菌占52.52%,革兰阳性菌占40.37%,真菌占7.11%;大肠埃希菌和肺炎克雷伯菌对阿米卡星、庆大霉素、氯霉素的耐药率分别为5.26%、46.32%、35.79%和12.50%、25.00%、33.33%,洋葱伯克霍尔德菌对亚胺培南、阿米卡星、庆大霉素的耐药率均为100.00%;金黄色葡萄球菌和表皮葡萄球菌对青霉素G、红霉素、苯唑西林的耐药率分别为93.75%、83.33%、75.00%和93.55%、70.97%、74.19%,其对万古霉素的耐药率均为0。结论医院获得性血流感染患者的病原菌以革兰阴性菌为主,在临床使用抗菌药物时,应先进行血培养及药敏试验,从而有效预防机体耐药性以及耐药菌株的产生。

OBJECTIVE To investigate the distribution and drug resistance of pathogens isolated from patients with nosocomial bloodstream infections. METHODS Totally 383 patients with nosocomial bloodstream infections from Jan 2009 to Oct 2012 were collected, and the results of bacteria culture and drug resistance were analyzed retrospectively. RESULTS A total of 436 strains of pathogenic bacteria were isolated from 383 patients, including gram-negative bacteria 52.52 %, gram-positive bacteria 40.37 %, and fungi 7.11%. The drug resistance rates of Escherichia coli and Klebsiella pneumonia to amikacin, gentamicin and chloramphenicol were 5.26%, 46.32%, 35.79% and 12. 50%, 25.00%, 33.33%, respectively. The drug resistance rates of Burkholderia cepacia to imipenem, amikacin and gentamicin were all 100.00 %. The drug resistance rates of Staphylococcus aureus and S. epidermidis to penicillin G, erythromycin and oxacillin were 93.75%, 83.33%, 75.00% and 93.55%, 70.97%, 74.19%, respectively, and no strains were found resistant to vancomycin. CONCLUSION Gram-negative bacteria were the major pathogens in patients with nosocomial bloodstream infections. Blood culture and drug sensitive test should be performed before use of antibacterials to prevent from the occurrence of drug resistant pathogens.