平谷地区血流感染病原菌种类及耐药性研究

Pathogens and Antibiotic Resistance of Bloodstream Infections in Pinggu County Area

目的调查平谷地区临床血流感染(bloodstream infections,BSI)患者的发病原因、病原菌种类及耐药特点。方法对临床可疑BSI患者进行血培养,对分离菌株进行鉴定,并进行抗生素敏感性测试。结果本研究血培养阳性453例(12.84%),同一患者重复菌株28例,其中有基础疾病397例,无基础疾病28例。分离出革兰阴性菌281株(62.03%),革兰阳性菌172株(37.97%)。检出率前5位的病原菌依次为大肠埃希菌(26.49%)、人葡萄球菌(8.39%)、鲍曼不动杆菌(8.17%)、表皮葡萄球菌(7.28%)、阴沟肠杆菌(4.86%)。主要革兰阴性菌中,阴沟肠杆菌对氨苄西林全部耐药,对头孢呋辛耐药率为55.56%;大肠埃希菌耐药率检测氨苄西林为84.17%,复方新诺明71.67%,头孢呋辛50%。鲍曼不动杆菌对头孢哌酮/舒巴坦全部敏感,对米诺环素、替加还素耐药率均为5.40%;铜绿假单胞菌对羧苄西林耐药率13.64%。主要革兰阳性菌对青霉素、红霉素耐药率粪肠球菌为14.29%、71.43%,人葡萄球菌为84.21%、84.21%,表皮葡萄球菌为87.88%、78.78%,金黄色葡萄球菌为57.14%、35.71%。结论临床BSI以有基础疾病者为主,革兰阴性菌分离率及耐药率均较高,应加强本地区抗菌药物的使用和管理,以减少耐药性。

Objective To investigate the cause of clinical bloodstream infection （bloodstream infections, BSI） in pa-tients with pathogenesis, pathogenic species and drug resistance characteristics in Pinggu Area. Methods Blood culture, iden-tification of isolates, and antibiotics sensitivity test of suspected BSI patients were performed. Results In this study, blood cul-ture was positive in 453 patients （12. 84%）, which had underlying diseases in 397 cases, 28 cases had duplicated strains in the same patient, but did not have underlying diseases. 281 strains of gram negative bacteria （62. 03%） and 172 strains of gram positive bacteria （37. 97%） were isolated. The detection rate of top 5 pathogens were Escherichia coli （26. 49%）, Staphylococ-cus hominis （8. 39%）, Acinetobacter baumannii （8. 17%）, Staphylococcus epidermidis （7. 28%） and Enterobacter cloace （4. 86%）. The main gram negative bacteria, Enterobacter cloacae to ampicillin were resistant and resistance rate to cefuroxime rate was more than 50%. Escherichia coli to ampicillin resistance rate was 84. 17%, sulfamethoxazole resistance rate was 71. 67%, and resistance rate to cefuroxime was more than 50%. Acinetobacter baumannii was sensitive to Cefperazone-Sulbac-tam. For minocycline and Tigecyclinefor, the resistance rate was 5. 40%. For Pseudomonas aeruginosa to carboxy ampicillin the resistant rate was 13. 64%. For main gram-positive bacteria erythromycin, resistance rate to penicillin： Enterococcus faecalis was 14. 29%, 71. 43%, and staphylococcus hominis was 84. 21% and 84. 21%, Staphylococcus epidermis was 87. 88% and 78. 78%, Staphylococcus aureus was 57. 14% and 35. 71%. Conclusion BSI has underlying diseases in most cases. Clinical gram negative bacilli isolation rate and drug resistance rate are high. The local antibiotic use and management of drug resistance should be strengthened to reduce the occurrence of antibiotic resistance rate.