血培养分级报告在优化抗生素治疗中的应用价值

Application value of blood culture grading report on optimizing antimicrobial therapy

目的:探讨血培养分级报告在血流感染患者调整优化抗感染治疗中的应用。方法:回顾性调查2011年1月至2013年12月期间169例血流感染患者的病原菌分布和耐药性情况,统计分析血培养阳性菌分级报告与优化抗生素治疗决策之间的相关性。结果:血培养阳性菌169株,其中革兰阳性球菌占全部阳性菌株数的46.7%,革兰阴性杆菌占49.7%,真菌占3.6%。感染率居前5位的细菌是大肠埃希菌、凝固酶阴性葡萄球菌、金黄色葡萄球菌、肠球菌和肺炎克雷伯菌。血培养初级报告在24、48、72、96 h内发出的比例分别为65.7%、85.8%、95.9%和99.4%;初级和次级报告较最终报告分别提前42 h和29 h。耐甲氧西林葡萄球菌阳性率66.7%,携超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌的阳性率57.8%。血培养阳性初级报告发出前经验用药比例达95.3%,与细菌药敏试验结果的符合率为46.7%。与初级、次级和最终报告相关的抗菌药物调整率分别为36.1%、21.9%和10.6%。经验用药使用率居前3位的分别是亚胺培南或美洛培南(40.2%)、头孢哌酮/舒巴坦(33.1%)和头孢曲松(25.4%)。结论:血流感染的细菌分布和耐药谱特征是经验用药的参考依据,血培养分级报告对优化抗菌药物治疗有重要指导价值,其中初级报告是最关键一步。

Objective： To investigate the guiding significance of blood culture grading report on the adjustment and optimization of antibiotic therapy. Methods： Distribution and drug resistance of pathogens in 169 cases of patients with bloodstream infection who were admitted into hospital from Oct. 2011 to Sep. 2013 were analysized retrospectively. Statistical analysis was applied to investigate the correlation between blood culture grading report and optimizing antibiotic treatment decisions. Results： One hundred sixty-nine strains of bacteria or fungi were isolated from the patients. The isolates included Gram-positive bacteria （46.7%）, Gram-negative bacteria （49.7%） and fungi（3.6% ）. Escherichia coli（E, coli）, coagulase-negative staphylococcus, staphylococcus aureus, enterococcus and klebsiella pneumoniae were in top five. The proportion of primary blood culture reports issued in 24, 48, 72, 96 h were 65.7%, 85. 8%, 95.9% and 99. 4%, respectively; The Primary and secondary reports were earlier than the final reports 42 h and 29 h, respectively; Methicillin-resistant Staphylococcus aureus-positive rate was 66. 7%; 57. 8% E. coli and Klebsiella pneumoniae were found carrying extended spectrum beta lactamases （ESBLs）. 95.3% of medication were used before the outcome of blood culture, antibiotics adjustment related to primary. Secondary and final reports were 36.9 %, 26. 1% and 10. 6%. With empirical treatment utilization among the top three drugs were imipenem or meropenem （40.2%）, cefoperazone sulbactam （33.1%） and ceftriaxone（25.4% ）. Conclusions： Distribution and spectral characteristics of bacterial resistance are important reference of experience drug-treating in patients with bloodstream infection. The grading report of blood culture plays an important role on guiding and optimizing antibiotic therapy, of which the primary report is the most critical step.