2012—2015年某三甲医院血培养常见病原菌及其耐药性变迁

Distribution and changes in antimicrobial resistance of pathogens from blood culture in a tertiary first-class hospital in 2012-2015

目的：了解血流感染病原菌种类分布及其耐药性变迁，为临床合理使用抗菌药物提供参考。方法对2012—2015年某三甲医院送检血培养标本分离的主要病原菌及其耐药性进行统计分析。结果共检出病原菌4780株，居前5位的依次为大肠埃希菌1008株（21．09％），肺炎克雷伯菌624株（13．05％），鲍曼不动杆菌452株（9．46％），金黄色葡萄球菌437株（9．14％），铜绿假单胞菌247株（5．17％）。其中以革兰阴性（G－）杆菌为主，占62．05％，其次为革兰阳性（G＋）球菌（29．31％）、真菌（7．76％）及其他（0．88％）。肺炎克雷伯菌对厄他培南和亚胺培南的耐药率由2012年的4．50％，分别提高至2015年的46．79％、33．94％（均 P ＜0．01）。鲍曼不动杆菌对头孢吡肟、头孢他啶、妥布霉素、庆大霉素和亚胺培南总耐药率分别为86．50％、80．56％、78．10％、79．87％和84．29％；2012—2015年阿米卡星耐药率依次为0、10．22％、39．85％和21．30％（P ＜0．01）；4年间米诺环素耐药率为0～7．52％（P ＜0．01）。结论该院血流感染主要病原菌为 G－杆菌，其中鲍曼不动杆菌对头孢类和碳青霉烯类抗生素耐药性极高，肺炎克雷伯菌对碳青霉烯类抗生素的耐药率增长迅速。临床应谨慎使用广谱抗菌药物，以降低抗菌药物选择压力。

Objective To investigate the distribution and change in antimicrobial resistance of pathogens causing blood-stream infection,so as to provide reference for rational antimicrobial use.Methods The isolation and antimicrobial resistance of major pathogens from blood culture specimens from a tertiary first-class hospital in 2012-2015 were analyzed statistically.Results A total of 4 780 isolates were detected,the top five species were Escherichia coli （n = 1 008, 21.09%）,Klebsiella pneumoniae （n = 624,13.05%）,Acinetobacter baumannii （n = 452,9.46%）,Staphylococcus aureus （n=437,9.14%）,and Pseudomonas aeruginosa （n=247,5.17%）.The percentage of gram-negative bacilli, gram-positive cocci,fungi,and others were 62.05%,29.31%,7.76%,and 0.88% respectively.The resistance rates of Klebsiella pneumoniae to ertapenem and imipenem increased from 4.50% in 2012 to 46.79% and 33.94% in 2015（both P〈0.01）.The resistance rates of Acinetobacter baumannii to cefepime,ceftazidime,tobramycin,gentamicin,and imipenem were 86.50%,80.56%,78.10%,79.87%,and 84.29% respectively;resistance rates to amikacin in 2012-2015 were 0, 10.22%,39.85%,and 21.30% respectively（P〈0.01）;resistance rates to minocycline in four years were 0-7.52% （P〈0.01 ）.Conclusion The main pathogens causing bloodstream infection are gram-negative bacilli,Acinetobacter baumannii is highly resistant to cephalosporins and carbapenems,resistance rates of Klebsiella pneumoniae to carbapenems increased rapidly.Broad-spectrum antimicrobial agents must be used cautiously to reduce the selective pressure of＆amp;nbsp;antimicrobial agents.