血培养病原菌分布及耐药性分析

Distribution and drug resistance of pathogens of blood culture

目的了解2012年1月至2014年10月血培养分离的病原菌种类及耐药性,为今后临床用药提供参考。方法送检的血培养瓶采用BD BACTEC9240全自动血培养仪进行培养,细菌的鉴定和药敏试验采用梅里埃公司VITEK 2-Compact全自动微生物分析仪,药敏试验采用纸片扩散法。结果共送检血培养标本12 804份,分离鉴定出病原菌共791株,检出率为6.2%,其中革兰阳性球菌405株,占51.2%,革兰阴性杆菌375株,占47.4%,真菌11株,占1.4%。主要革兰阳性菌为凝固酶阴性葡萄球菌(26.0%)、金黄色葡萄球菌(10.9%)和屎肠球菌(3.4%)等。主要革兰阴性菌为大肠埃希菌(18.7%)、肺炎克雷伯菌(10.9%)、鲍曼不动杆菌(7.0%)等。其中检出病原菌前三位的科室分别是ICU(35.7%)、神经外科(14.5%)和肾内科(10.7%)。主要革兰阳性菌对利奈唑胺、万古霉素、奎奴普丁/达福普汀耐药性较弱;主要革兰阴性菌对亚胺培南、美洛培南、阿米卡星耐药性较低。结论血培养分离的革兰阳性菌和革兰阴性菌均较高,不仅菌种多样,科室分布也不同,不同菌种之间耐药性差异较大,应定期监测病原菌耐药性,联合应用不同抗生素方案进行治疗。

Objective To analyze the distribution and drug resistance of pathogens cultured from blood samples from January 2012 to October 2014 and provide the theoretical foundation for the future clinical application. Methods Blood culture samples were cultured by BD BACTEC9240 automatic blood culture system. The pathogens of the positive blood culture samples were identified by VITEK2-Compact automatic microbiology system,and tested for drug susceptibility testing by MIC and disk diffusion method. Results A total of 12 804 blood culture samples were inspected from January2012 to October 2014 in our hospital; 791 pathogenic bacteria were isolated（6.2%）. In which, 405 strains（51.2%）were gram-positive cocci,375（47.4%） strains were gram-negative bacilli, and 11 were fungi strains（1.4%）. Main grampositive bacteria were coagulase negative staphylococcus（26.0%）, Staphylococcus aureus（10.9%）, Excrement aureus（3.4%）, etc. Main gram-negative bacteria were E. coli（18.7%）, Klebsiella pneumoniae（10.9%） and Acinetobacter baumannii（7.0%）. Pathogens were mainly detected in ICU（35.7%）, neurosurgery department（14.5%） and renal medicine department（10.7%）. The resistance rates of main gram-positive coccus bacteria to linezolid, vancomycin, and quinupristin / dalfopristin were low. The resistance rates of main gram-negative bacteria to imipenem, meropenem and amikacinwere low. Conclusions There were high detection rates with gram-positive bacteria and gram-negative bacteria in blood cultures, with wide spectrum,from different departments, and with different drug resistance. Regular monitoring of the pathogen drug resistance was important for rational use of antibiotics.