血培养阳性混合菌感染的病原菌分布及耐药性分析

Distribution and drug resistance of the pathogens mixed bacterial infection isolated from blood culture

目的探讨血培养阳性混合菌感染的病原菌的分布及对常用抗菌药物的耐药情况,以指导临床合理用药。方法收集2010~2013年首都医科大学附属北京友谊医院临床床检验中心分离血培养阳性的混合菌感染病原菌,病原菌鉴定采用生物梅里埃VITEKcompact2自动鉴定系统,药敏试验采用肉汤微量稀释法。结果血培养阳性的混合菌感染病例共分离原菌102株共51组混合菌每组均为两种菌,混合感染菌株组合前3位的分别是大肠埃希菌＋屎肠球菌8例（15.7%）,大肠埃希菌＋肺炎克雷伯菌、大肠埃希菌＋金黄色葡萄球菌和铜绿假单胞菌＋金黄色葡萄球菌各3例（5.9%）。鲍曼不动杆菌＋大肠埃希菌、鲍曼不动杆菌＋屎肠球菌,大肠埃希菌＋铜绿假单胞菌、粪肠球菌＋铜绿假单胞菌,屎肠球菌＋肺炎克雷伯菌各2例（3.9%）。革兰阴性杆菌60株（58.8%）,革兰阳性球菌38株（37.3%）,真菌4株（3.9%）。前5位的菌分别是大肠埃希菌21株（20.6%）,屎肠球菌16株（15.7%）,铜绿假单胞菌10株（9.8%）,鲍曼不动杆菌9株（8.8%）,肺炎克雷伯菌和金黄色葡萄球菌各8株（8.1%）。耐甲氧西林金黄色葡萄球菌（MRSA）的检出率为75%,耐万古霉素屎肠球菌（VRE）为18.8%。结论血培养阳性混合菌感染以革兰阳性菌合并革兰阴性菌和两种革兰阴性菌合并感染两种组合为主,革兰阴性菌所占比率高于革兰阳性菌,病原菌的耐药情况比较严重,应定期对病原菌的耐药性进行监测,以便指导临床合理应用抗生素。

Objective To investigate the distribution and drug resistance of the pathogens mixed bacterial infection isolated from blood culture and instruct the clinic to use drug reasonably. Methods The authors collected the pathogens mixed bacterial infection isolated from blood culture from 2010 ~ 2013 in Clinical Laboratory Center of Beijing Friendship Hospital,Capital Medical University. These pathogens were identified by Vited 2 automated microbiological analyzer. The author performed the drug susceptibility test by broth microdilution. Results 102 pathogens mixed bacterial infection isolated from blood culture were collected from 51 case. The mixed infection with 2 kinds of pathogens were found in 51 cases. The top 3 places of mixed infection Escherichia coli ＋ Enterococcus faecium 15. 7%（ 8）. Escherichia coli ＋ Klebsiella pneumonia. Escherichia coli ＋ Staphylococcus aureus,Pseudomonas aeruginosa ＋ Staphylococcus aureus all three stains each 5. 9%. Acinetobacter baumannii ＋Escherichia coli,Acinetobacter baumannii ＋ Enterococcus faecium,Escherichia coli ＋ Pseudomonas aeruginosa,Enterococcus faecalis ＋ Pseudomonas aeruginosa,Enterococcus faecium ＋ Klebsiella pneumoniae all two stains each 3. 9%. Gram-positive cocci and Gram-negative bacilli and fungus accounted for 58. 8%（ 60）,37. 3%（ 38） and 3. 9%（ 4）. The top 5 places were Escherichia coli 20. 6%（ 21）,Enterococcus faecium15. 7%（ 16）,Pseudomonas aeruginosa 9. 8%（ 10）,Acinetobacter baumannii8. 8%（ 9）,Klebsiella pneumoniae and Staphylococcus aureus8. 1%（ 8）. The prevalence of MRSA among Staphylococcus aureus was 75%. VRE was identified in 18. 8% of the Enterococcus faecium iso-lates. Conclusion The gram positive bacteria merged gram- negative bacteria and two kinds of gram- negative bacteria infection two combination in blood culture positive for mixed bacteria infection is given priority. The proportion of gram- negative bacteria is higher than gram- positive bacteria. The pathogen resistance situation is serious,which should be conducted on a regular basis to monitor the drug resistance of pathogenic bacteria,in order to guide clinical rational use of antibiotics.