血流感染病人的病原菌分析

ANALYSIS OF THE DISTRIBUTION AND ANTIMICROBIAL SUSCEPTIBILITY PROFILES OF PATHOGENIC BACTERIA ISOLATED FROM INPATIENTS WITH BLOOD BACTERIAL INFECTION

目的：研究内蒙古自治区人民医院2011-01~2014-09血流感染病原菌的分布及耐药状况,为临床治疗血流感染提供参考依据。方法：采用MIC法测定细菌药物敏感性,使用WHONET 5.6软件,对我院2011-01~2014-09血培养分离的菌株进行分析。结果：共分离病原菌913株,包括革兰阳性菌412株（45.1%）、革兰阴性菌417株（45.7%）和念珠菌属24株（2.6%）,分离最多的为大肠埃希菌,共256株（28.0%）,其次人葡萄球菌人亚种168株（18.4%）、克雷伯菌属83株（9.1%）、金黄色葡萄球菌56株（6.1%）和肠球菌属50株（5.5%）;耐甲氧西林金黄色葡萄球菌和凝固酶阴性葡萄球菌的检出率分别是47.4%和84.2%,没有发现耐万古霉素金黄色葡萄球菌和凝固酶阴性葡萄球菌;粪肠球菌和屎肠球菌中分别有2.7%和1.3%对万古霉素耐药;大肠埃希菌和肺炎克雷伯菌ESBLs的阳性率分别为43.6%和35.2%,对氨苄西林耐药率分别为87.7%和85.4%;大肠埃希菌对喹诺酮类药物的耐药率在60%以上。结论：我院血流感染细菌以大肠埃希菌、葡萄球菌属和克雷伯菌属最多见;对头孢类和喹诺酮类药物的耐药率明显较高,临床应依据药敏报告结果合理选用抗菌药物。

Objective： To provide reference data for clinical treatment bacterial blood infection through investigating the distribution and antimicrobial susceptibility profiles of pathogenic bacteria isolated from blood samples from the inpatients hospitalized between January,2011 and September,2014.Methods： MIC method was used to test the antimicrobial susceptibility of the bacterial isolates and WHONET 5. 6 version software was used to analyze the isolates from blood samples of the inpatients between January,2011 and September,2014. Results： A total of 913 isolates were separated which were composed of 412 isolates of gram positive bacteria（ 45. 1%）,417 isolates of gram negative bacteria（ 45. 7%） and 24 isolates of candida species（ 2. 6%）. Among these isolates,the most isolated bacteria was E. coli（ 256,28. 0%）,followed by Staphylococcus aureus subspecies（ 168,18. 4%）,Klebsiella spp（ 83,9. 1%）,staphylococcus aureus（ 56,6. 1%） and Enterococcus species（ 50,5. 5%）. The isolation rate of oxacillin resistant staphylococcus aureus and coagulase negative staphylococci were 47. 4%and 84. 2%. No vancomycin resistant staphylococcus aureus strains was isolated. The vancomycin resistance rates of Enterococcus faecalis and Enterococcus faecium were 2. 7% and 1. 3% respectively.ESBLs positive rates for E. coli and klebsiella pneumoniae were 43. 6% and 35. 2%,respectively. The resistance rate of E. coli and klebsiella pneumoniae isolates to ampicillin were 87. 7% and 85. 4%,respectively. The resistance rate of E. coli to fluoroquinolones was higher than 60%. Conclusions： The most isolated bacterial pathogens separated from blood samples were E. coli,staphylococci and Klebsiella spp. The resistance rates to cephalosporins and fluoroquinolones were higher significantly. Rational antimicrobials should be selected based on the drug susceptibility test report.