191株血培养病原菌分布及其耐药性分析

Analysis on distribution and drug resistance of pathogenic bacteria in blood culture

目的:了解血培养标本中常见病原菌的分布及其耐药情况,为临床合理使用抗生素提供科学依据。方法:采用法国生物梅里埃公司BACT/ALERT 3D全自动血液培养仪培养,VITEK 2 Compact全自动细菌鉴定及药敏分析系统对培养阳性标本进行细菌鉴定以及药敏实验,药敏结果采用CLSI 2012年标准判断。结果:2347例血培养标本中分离病原菌191株,阳性率为8.14%。革兰阳性球菌共78例,占40.84%,革兰阴性杆菌106例,占55.50%;真菌7例,占3.66%。数量最多的四位病原菌依次为大肠埃希菌(25.13%)、凝固酶阴性葡萄球(19.37%)、肺炎克雷伯菌(12.57%)、金黄色葡萄球菌(7.33%)。耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)和耐甲氧西林金黄色葡萄球菌(MRSA)的检出率分别为67.57%和42.86%;产ESBLs大肠埃希菌和肺炎克雷伯菌分别为60.47%和20.83%。结论:血培养中病原菌种类复杂,以肠杆菌和葡萄球菌为主,主要病原菌耐药情况严重。

Objective： To analyze the distribution and drug resistance of pathogenic bacteria in blood culture,and provide a scientific basis for accurate clinical use of antibiotics. Methods： Blood was cultured by using BACT / ALERT 3D automatic blood culture instrument. Positive blood culture for bacterial was identified,drug sensitivity tests were conducted by using VITEK 2 Compact automatic,and drug susceptibility results were analyzed by using CLSI 2012 standard. Results： 191 strains of pathogenic bacteria were detected from2347 cases of blood culture. The positive rate was 8. 14%,and there were 78 strains of Gram-positive bacteria（ 40. 84%）,106 strains of Gram-negative bacteria（ 55. 50%）,and 7 strains of fungi（ 3. 66%）. The top four were Escherichia coli（ 25. 13%）,coagulase-negative staphylococci（ 19. 37%）,Klebsiella pneumonia（ 12. 57%） and Staphylococcus aureus（ 7. 33%）. The incidences of MRSCN and MRSA were 67. 57% and 42. 86%. The extended spectrumβ lactamases（ ESBLs） positive rates of E. coli and K. pneumoniae were60. 47% and 20. 83%. Conclusion： Pathogenic bacteria from blood culture are complex in variety,most of which are Enterobacteraceae and Staphylococcus spp. The situation of drug resistance to main pathogenic bacteria is serious.