综合ICU血培养阳性标本病原菌的分布及耐药性分析

Distribution and antimicrobial resistance of pathogens in positive blood culture in General Intensive Care Unit

目的:分析近5年我院综合ICU血培养阳性标本病原菌的分布及耐药性情况。方法:回顾性调查分析2009-01-2013-12住院患者临床血培养阳性标本药敏试验结果。结果:共分离出病原菌208株,其中革兰阳性球菌占61.5%,革兰阴性杆菌占34.6%,真菌占3.9%。凝固酶阴性葡萄球菌(CNS)(39.4%)最多,其余依次为肠杆菌科细菌(27.4%),金黄色葡萄球菌(11.5%)、肠球菌属细菌(8.7%)、非发酵革兰阴性杆菌(6.3%)、真菌。未发现对万古霉素、替考拉宁、利奈唑胺耐药的葡萄球菌。屎肠球菌中检出耐万古霉素和替考拉宁耐药菌1株。肺炎克雷伯菌对碳氢酶烯类耐药率为16.7%,未检出其他耐碳氢酶烯类的肠杆菌科菌株。头孢哌酮-舒巴坦对非发酵革兰阴性杆菌耐药率在20.0%以下。真菌以白色念珠菌为主,对目前主要抗真菌药物敏感率均较高。结论:综合ICU是血流感染的高发区,了解本科室血培养阳性标本病原菌的分布以及进行耐药性监测,对制定经验治疗方案,指导抗生素的临床合理用药具有一定的参考价值。

Objective：To investigate the distribution and antimicrobial resistance of pathogens in positive blood culture in the past five years in our general intensive care unit. Method： Pathogenic bacteria isolated from specimens of positive blood culture during the period of Jan. 2009-Dec. 2013 were identified and drug susceptibility tests were performed. Result： A total of 208 strains were isolated from blood specimens. Gram positive cocci and Gram negative bacilli accounted for 61.5% and 34.6% ,respectively,and fungus accounted for 3.9%. The most frequent isolates were coagulase negative Staphylococcus （CNS）（39.4%）, the rest frequent isolates were Enterobacteriaceae （27.4 % ）, Staphylococcus aureus （ 11.5 % ）, Enterococcus （8.7% ）, Nonfermenters （6.3 % ）, fungus. No Staphylo- coccus strain was resistant to vancomycin, teicoplanin and linezolid. One Enterococcus faecium stra＇in was resistant to vancomycin and teicoplanin. Carbapenem resistance was identified in 16.7% of the klebsiella pneumoniae,and no strains were found resistant to Carbapenem in the other Enterobacteriaceae. Less than 20 % of nonfermenters were resistant to Cefperazone Sulbactam. Candida albicans was the main pathogen of Fungemia,and fungus were sensitive to antifungal agents mostly. Conclusion：The incidence rates of bloodstream infections were higher in general Intensive Care Unit. It has a certain reference value to make the experimental treatment plan,guide appropriate selection of antibiotics in clinical practice by investigating the distribution and antimicrobial resistance analysis of pathogens in positive blood culture from own division.