2010-2011年血液感染病原菌分布及耐药性分析

Analysis of distribution and drug resistance of pathogens causing blood infections from 2010 to 2011

目的探讨医院血液感染病原菌的临床分布及耐药性,为医院血液感染的临床诊断与治疗提供试验依据和诊治参考。方法收集2010年1月-2011年12月门诊和住院患者血培养标本13 500份,严格按《全国临床检验操作规程》进行细菌分离培养鉴定及药敏试验,数据采用SPSS13.0软件进行统计分析。结果 13 500份血培养标本,共分离出病原菌972株,其中革兰阳性菌366株占37.7%、革兰阴性菌557株占57.3%、真菌49株占5.0%;革兰阴性菌中嗜麦芽寡养单胞菌对磺胺甲噁唑/甲氧苄啶、头孢他啶、头孢哌酮/舒巴坦等耐药率,分别为47.7%、43.3%、22.6%;革兰阳性菌中金黄色葡萄球菌、表皮葡萄球菌对青霉素的耐药率最高,分别为91.8%、93.1%;真菌对常用抗真菌药物耐药率均较低;产超广谱β-内酰胺酶大肠埃希菌检出率为46.6%、肺炎克雷伯菌检出率为28.2%。结论对血培养病原菌进行早期监测和耐药性分析非常必要,对控制感染、指导合理使用抗菌药物、减缓耐药菌株的出现具有重要的临床意义。

OBJECTIVE To explore the clinical distribution and drug resistance of pathogens causing nosocomial blood infections ,so as to provide the basis and theoretical guidance for clinical diagnosis and treatment of the nosocomial blood infections .METHODS The blood cultures obtained from 13 ,500 inpatients and outpatients who were hospitalized from Jan 2010 to Dec 2011 ,then the bacteria isolation culturing identification and drug sensitive test were performed strictly according to the criteria of clinical laboratory standards institute 2010 edition ,and the data were statistically analyzed by using SPSS13 .0 software .RESULTS A total of 972 strains of pathogens have been isolated from the 13 ,500 cases of blood culture specimens ,including 366 strains of gram-positive bacteria （37 .7% ） ,557 strains of gram-negative bacteria （57 .3% ） and 49 strains of fungi （5 .0% ）;in the gram-negative bacteria , the drug resistance rates of Stenotrophomonas maltophilia to sulfamethoxazole/trimethoprim , ceftazidime ,cefoperazone/sulbactam were 47 .7% , 43 .3% , and 22 .6% , respectively ;in the gram-positive bacteria ,the drug resistance rates of Staphylococcus aureus （91 .8% ） and S .epidermidis （93 .1% ） to penicillin were the highest ;the drug resistance rates of fungi to the commonly used antimicrobials were lower ;the detection rates of extended-spectrum β-lactamase producing Escherichia coli and K lebsiella pneumoniae was 46 .6% and 28 .2% respectively .CONCLUSIONS It′s very necessary to carry out the early monitoring of the blood cultures and analysis of the drug resistance ,which is of great clinical significance to control infections ,provide guidance for rational use of antimicrobials ,and slow down the emergence of the resistant strains .