463株血培养阳性病原菌分布及耐药分析

Analysis of Pathogen Distribution and Drug Resistance of 463 Strains of Blood Culture Positive

目的:分析我院2014年检出的463株血培养阳性菌的分布及耐药状况。方法:回顾经BD 9240和Bact/Alert3D 240血培养系统进行培养,使用Vitec2 compact对分离菌株鉴定及药敏试验。数据分析采用Whonet 5.6软件。结果:463株非重复分离菌中革兰阴性菌286株(61.77%);革兰阳性菌156株(33.69%);真菌21株(4.54%)。本研究共检出金黄色葡萄球菌29株,其中耐甲氧西林金黄色葡萄球菌(MRSA)7株(24.14%);甲氧西林敏感金黄色葡萄球菌(MSSA)22株(75.86%);凝固酶阴性葡萄球菌(CNS)92株,其中耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)81株(88.04%),甲氧西林敏感凝固酶阴性葡萄球菌(MSCNS)11株(11.96%)。MSSA与MRSA在庆大霉素、利福平、万古霉素、利奈唑胺、替考拉宁、环丙沙星、左氧氟沙星耐药率方面有差异(P<0.05)。MRCNS与MSCNS在万古霉素、利奈唑胺、替考拉宁、庆大霉素、环丙沙星、左氧氟沙星、复方磺胺甲唑耐药率方面有差异(P<0.05)。屎肠球菌对青霉素耐药率为90.9%,未检出对万古霉素耐药的屎肠球菌。产超广谱β内酰胺酶(ESBLs)大肠埃希菌占比52.59%。产ESBLs肺炎克雷伯菌占比40.32%。产ESBLs大肠埃希菌菌株与非产ESBLs菌株在氨曲南、头孢他啶、氯霉素、环丙沙星、头孢曲松、头孢噻肟、头孢吡肟、头孢唑林及左氧氟沙星耐药率方面有差异(P<0.05)。产ESBLs肺炎克雷伯菌菌株与非产ESBLs菌株在氨曲南、头孢他啶、氯霉素、环丙沙星、头孢曲松、头孢噻肟、头孢吡肟、头孢唑林、左氧氟沙星、头孢西丁及氨苄西林-舒巴坦耐药率方面有差异(P<0.05)。铜绿假单胞菌检出3株泛耐药菌株(15.78%),鲍曼不动杆菌泛耐药菌株4株(22.22%),沙门氏菌耐药率均低于6.5%。结论:血培养阳性分离菌分布广泛,不同病原菌间耐药性亦不相同。应加强对血培养病原菌分布和耐药性的监测。

ABSTRACTObjective：To investigate and analyze the pathogen distribution and drug resistance of 463 strains of blood culture positive detected in our hospital in 2014.Methods：BD 9240 and Bact/Alert3D 240 blood culture sys-tems were used. Identification and drug sensitive test of the isolated bacterial strains were conducted using Vitec2 compact. Data was analyzed by Whonet 5.6 software.Results：In the study 286 strains（61.77%）were detected as the Gram-negative bacteria,156 strains（33.69%）were Gram-positive,and 21 strains（4.54%）were fungi. About 29 strains were detected asStaphylococcusaureus,including 7 MRSA strains（24.14%）,22 MSSA strains（75.86%）and 92 strains ofcoagulase-negativestaphylococcus,with 81 MRCNS strains（88.04%）and 11 MSCNS strains（11.96%）. Significant difference of resistant rates（P〈0.05）of MRSA and MSSA were showed to gen-tamycin,rifampin and vancomycin,linezolid,teicoplanin,ciprofloxacin and levofloxacin and significant difference of resistant rates of MRCNS and MSCNS（P〈0.05）were found in vancomycin,linezolid,teicoplanin,gentamycin, ciprofloxacin,levofloxacin and compound sulfamethoxazole. The resistant rate ofEnterococcusfaeciumto penicillin was 90.9% but no resistance was detected to vancomycin. The strains of ESBLs inE.coliwere accounted for 52.59% and 40.32% was ESBLs inKlebsiellapneumoniae. There were different resistant rates（P〈0.05）ofE.coli（ES-BLs ＋）andE.coli（ESBLs-）in aztreonam,ceftazidime,chloramphenicol,ciprofloxacin,ceftriaxone,cefotaxime, cefepime,levofloxacin and cefazolin. The different resistant rates（P〈0.05）ofKlebsiellapneumoniae（ESBLs ＋） andKlebsiellapneumoniae（ESBLs-）were showed in aztreonam,ceftazidime,chloramphenicol,ciprofloxacin,cef-triaxone,cefotaxime,cefepime,cefoxitin,ampicillin/sulbactam,levofloxacin and cefazolin. Three strains（15.78%） of pan-drug resistantPseudomonasaeruginosaand 4 strains（22.22%）of pan-drug resistantAcinetobacterbaumannii were detected. The resistant rate ofsalmonellawas less than 6.5%.Conclusion：There is a wide distribution of positive isolates from blood culture and the resistance rates of different bacteria varied. The monitoring of pathogenic distribution of blood culture and drug resistance should be strengthened.