2014-2017年医院血流感染病原菌分布及耐药性变迁

The distribution of pathogenic bacteria and the change of drug resistance in nosocomial bloodstream infection in 2014-2017

目的探究2014-2017年医院血流感染的病原菌分布及耐药性的变迁情况。方法回顾性分析2014年1月-2017年1月医院送检的1 485例患者血液标本检测资料,其中血液感染的患者588例,根据血培养和药敏试验结果分析病原菌分布及耐药性变迁情况。结果 1 485份血液标本共有588份标本分离培养出病原菌624株,分离率为39.60%,其中革兰阴性菌361株占57.85%、革兰阳性菌209株占33.49%、真菌54株占8.65%;2016-2017年革兰阴性菌检出率较2014-2015年下降(χ2=0.742,P=0.826),革兰阳性菌检出率上升(χ2=0.428,P=0.916);主要革兰阴性菌对碳青霉烯类药物均敏感,对其他抗菌药物耐药率较高,且有逐年增加趋势;主要革兰阳性菌尚未发现对万古霉素耐药的现象,但对临床常用的青霉素、氨苄西林等抗菌药物耐药率较高;真菌对常见抗真菌药物均敏感。结论血流感染主要病原菌为革兰阴性菌,但革兰阳性菌有增长趋势,主要病原菌对临床常用抗菌药物耐药性明显,且有逐年增加趋势,值得临床注意。

OBJECTIVE To explore the distribution of pathogenic bacteria and change of drug resistance in nosocomial bloodstream infection in 2014-2017.METHODS The data on blood samples of 1 485 patients who were admitted for examination in the hospital from Jan.2014 to Jan.2017 were retrospectively analyzed,including 588 cases of patients with blood infection.The distribution of pathogenic bacteria and change of drug resistance were analyzed according to the results of blood culture and drug susceptibility test.RESULTS From 588 samples of the1 485 blood samples,624 strains of pathogens were isolated and cultured,with an isolation rate of 39.60%.There were 361 strains of gram-negative bacteria accounting for 57.85%,209 strains of gram-positive bacteria accounting for 33.49% and 54 strains of fungi accounting for 8.65%.The detection rate of gram-negative bacteria decreased from 2016-2017 to 2014-2015(X^2=0.742,P=0.826),whereas the detection rate of gram-positive bacteria increased(X^2=0.428,P=0.916).The major gram-negative bacteria were sensitive to carbapenems,and had relatively high resistance rates to other antimicrobial drugs,with an increasing trend year by year.The major gram-positive bacteria showed no resistance to vancomycin,but rather high resistance rates to the commonly used antibiotics such as penicillin and ampicillin.The fungi isolated were sensitive to common antifungal agents.CONCLUSIONThe main pathogens of bloodstream infection are gram-negative bacteria,but the gram-positive bacteria show a trend of growth.The main pathogens have obvious resistance to common clinical antibacterial drugs,and show a trend of increasing year by year,which is worthy of clinical attention.