1701株血培养临床分离菌的分布及其耐药性

Distribution and drug resistance of 1 701 positive isolates from blood culture samples

目的了解四川省人民医院血培养临床分离菌的分布及耐药性。方法采用自动血培养仪对2011年1月至2013年11月送检的18943份血液样本进行培养，对阳性的样本进行病原菌统计分析，并对其耐药性进行检测。结果共检出病原菌1701株，检出率为9．0％，其中革兰阳性球菌占52-3％．革兰阴性杆菌占45．8％，真菌1．9％。最多见的病原菌分别为凝固酶阴性葡萄球菌（CNS，37．7％）、大肠埃希菌（23．6％）、克雷伯菌属（8．8％）、肠球菌属（7-3％）和金黄色葡萄球菌（7．1％）。粪肠球菌对高浓度庆大霉素和氨苄西林的耐药率分别为71．4％和0，屎肠球菌对多数药物的耐药率显著高于粪肠球菌。未发现对万古霉素耐药的葡萄球菌，屎肠球菌对万古霉素的耐药率为5.3％。大肠埃希菌和克雷伯菌属对亚胺培南的耐药率为0．3％和0．7％，大肠埃希菌对氟喹诺酮类耐药率大于50％。肠杆菌属对亚胺培南和厄他培南耐药率分别为10．8％和19．4％。鲍曼不动杆菌对碳青霉烯类抗生素耐药率均在80％以上。结论3年间四川省人民医院血培养分离阳性病原菌以革兰阳性球菌和革兰阴性杆菌为主。耐药现象较为普遍。

Objective To investigate the distribution and drug resistance in blood culture isolates in Sichuan Provincial People＇s Hospital Methods A total of 18 943 blood culture samples obtained from January 2011 to November 2013 were performed by automated detection system. The pathogens and the drug resistance of positive isolates were analyzed. Results A total of 1 701 positive strains were isolated with the positive rate of 9.0%. Gram positive cocci , Gram negative bacilli and fungi accounted for 52.3% , 45.8% and i.9% ,respectively. The most frequent isolates were coagulase negative Staphylococcus （CNS, 37.7%）, E.coli （23.6%） ,Klebsiella spp. （8.8%）, Enterococcus spp. （7.3%） and S. aureu （7.1%）. The prevalence of E. faecalis strains resistant to high level gentamicin and ampicillin were 71.4% and 0, respectively. The E. faecium isolates showed significantly higher resistant rates to most of the antimierobial agents than E. faecalis ones.No Staphylococcus spp. strains were found resistant to vancomycin. The drug resistance rate of E. faecium to vancomycin was 5.3%. The resistance rates of E. coli and KlebsieUa spp. strains to imipenem were 0.3% and 0.7%, respectively.More than 50% of E. coli strains were resistant to fluoroquinolones. The resistance rates of Entrobacter spp. to imipenem and ertapenem were 10.8% and 19.4%, respectively. More than 80% ofAcinetobacter baumannii strains were resistant to carbapenems. Conclusions Mainly gram positive bacteria and gram negative bacilli were isolated from blood culture samples of the Sichuan Provincial People＇s Hospital in past 3 years, and resistance to antibiotics is common in most blood isolates.