63229份血培养标本中病原菌群分布及耐药性分析

Distribution and drug resistance of pathogens cultured from 63229 blood specimens

目的动态监测该院2007~2013年临床送检血培养标本中分离的病原菌分布及其耐药性变迁,为临床合理应用抗菌药物提供实验室依据。方法采用BACTEC全自动血培养仪对63 229份血液标本进行检测;细菌鉴定应用全自动细菌鉴定分析仪鉴定到种;细菌药敏试验采用纸片扩散（K-B）法,按照美国临床和实验室标准化协会（CLSI）规定的标准进行;病原菌分布和药敏试验结果应用Whonet5.6软件进行统计分析。结果从临床送检的63 229份血液标本中,培养阳性4 914份,阳性率7.77%,共检出病原菌2 196株,革兰阴性菌主要为大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌,检出率分别为25.50%、11.47%、7.14%、5.91%。革兰阳性菌中以凝固酶阴性葡萄球菌、金黄色葡萄球菌、肠球菌、草绿色链球为主,分离率分别为10.40%、7.42%、6.87%、3.91%。真菌分离率为7.40%（164/2 196）,产超广谱β-内酰胺酶的大肠埃希菌和肺炎克雷伯菌分离率分别为75.53%、55.51%。结论血流感染病原菌主要为大肠埃希菌、肺炎克雷伯菌、凝固酶阴性葡萄球菌、金黄色葡萄球菌,临床应严格按血培养标本的操作规范执行,避免污染并提高送检质量。

Objective To dynamic monitor and analyze pathogen distribution and drug resistance changes isolated from blood culture samples in our hospital from 2007 to 2013 years. Methods BACTEC automated blood culture system was used to detect 63 229 blood specimens, automatic identification of bacterial identification analyzer was applied to identify species, bacterial suscepti bility testing was detected by K-B method according to the American Society for Clinical Laboratory Standards Institute （CLSI） re- quirements standards. Pathogen distribution and antimicrobial susceptibility test results applied WhonetS. 6 software for statistical analysis. Results In 63 229 blood specimens,the positive rate was 7.77 % （4 914 specimens）, 2 196 strains were detected, mainly Gram negative bacteria were Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, the detec tion rates were 25.50 % , 11.47 %, 7. 14 %,5.91 %. Gram-positive bacteria to coagulase-negative staphylococci, Staphylococcus au reus,Enteroeoceus,grass green hammer main separation rates were 10.40% ,7.42% ,6.87% ,3.91~. Fungal 7.40~ （164/2 196）, producing ESBLs of Escherichia coli and Klebsiella pneumoniae separation rates were 75.53~, 55.51~~/00. Conclusion Bloodstream infection pathogen distribution as Escherichia coli,Klebsiella pneumoniae,coagulase-negative staphylococci, Staphylococcus aureus. Clinical blood culture specimens should be strictly in accordance with the norms adopted send execution to avoid pollution and im- prove the quality inspection.