血培养检出病原菌的分布及耐药性分析

Analysis of distribution and resistance of pathogens isolated from blood culture

目的 ：了解南京医科大学第一附属医院2014年血培养检出病原菌的分布及耐药性。方法 ：培养采用BACTEC FX全自动血培养仪;细菌、真菌鉴定及非苛养菌药物敏感试验采用VITEK-2 Compact全自动微生物鉴定及药敏系统,链球菌药敏为纸片扩散法（K-B法）,真菌药敏采用ATB FUNGUS 3;WHONET5.6软件进行统计分析。结果：2014年全年血培养共检出病原菌691株,双侧双瓶、双侧单瓶、单瓶阳性率分别为12.3%、11.4%、9.4%。分离率前5位菌种依次为大肠埃希菌（22.3%）、凝固酶阴性葡萄球菌（17.5%）、肺炎克雷伯菌（11.0%）、链球菌（7.2%）、肠球菌（7.1%）,革兰阴性菌分离率（50.4%）高于革兰阳性菌（41.0%）。血培养病原菌主要分离科室为血液科、重症监护病房、普外科及感染科。大肠埃希菌对头孢菌素类、单酰胺环类、喹诺酮类抗菌药物耐药率44.2%~79.9%,对氨基糖苷类、头霉素类、β-内酰胺/β-内酰胺酶抑制剂类及碳青霉烯类耐药率低于25.0%;肠球菌对多种抗菌药物耐药率高于50.0%;鲍曼不动杆菌对临床常规抗菌药物耐药率高于60.0%。结论：多套送检血培养有利于提高阳性率,血培养检出病原菌以革兰阴性菌为主,多种病原菌对临床常用抗菌药物耐药率高。

Objective：To investigate the distribution and resistance of pathogens isolated from blood culture of patients in the First Affiliated Hospital of Nanjing Medical University in 2014. Methods： All blood samples were cultured by BACTEC FX. Automatic detection machine of VITEK-2 Compact was used for identification of bacteria and fungus, as well as the susceptibility of non- fastidious bacteria. Susceptibility of streptococcus was tested by K-B method while susceptibility of fungus was tested by ATB FUNGUS 3. Whonet 5.6 software was used for statistical analysis. Results： The total of pathogen strains isolated from blood culture in 2014 was 691. The positive rates of three kinds of blood culture model, bilateral double bottles, bilateral single bottles and unilateral single bottle, were 12.3%, 11.4% and 9.4%, respectively. The top 5 bacteria were Escherichia coli（22.3%）, eoagulase negative staphylococcus （CNS, 17.5%）, Klebsiella pneumonia （11.0%）, Streptococcus （7.2%） and enterococcus （7.1%）. The separation rate of gram-negative bacteria （50.4%） was higher than that of gram-positive bacteria （41.0%）. The pathogens of blood culture were mainly isolated from the department of hematology, intensive care unit, general surgery, and infection. The resistance rates of Escherichia coli to cephalosporins, monobactam, quinolones were 44.2%-79.9%, and the resistance rates to aminoglycosides, cephamycins, [3- lactamase/13-1actamase inhibitors, and carbapenems were less than 25.0%. Enterococcus had a higher than 50.0% resistance rate to many kinds of antibiotics. We also found that the resistance rates of Acinetobacter baumanmii to all the clinical antibiotics were higher than 60.0%. Conclusion： Muhiple sets of inspection of blood culture helped to improve the positive rate. The pathogenic bacteria were dominated by gram-negative bacteria which had a relatively higher resistance rate to clinical antibiotics.