某三甲医院2010—2014年血液感染细菌的监测情况

Monitoring of bacterial infection in the blood in a Grade-3 Class-A hospital,2010—2014

目的了解海南省农垦总医院2010年1月—2014年12月患者血液标本分离的细菌谱及耐药情况,为感染性疾病治疗及合理使用抗菌药物提供实验依据。方法采用回顾性方法,对患者血液标本中分离鉴定的2 021株细菌进行统计和耐药率分析。结果除了血浆凝固酶阴性葡萄球菌外,2010年检出率最高的是肺炎克雷伯菌,而在2011—2014年,大肠埃希菌检出率位居第二位。5年血液细菌总阳性率6.3%(2 021/32 300),在分离的2 021株细菌中,革兰阴性杆菌占47.4%(958/2 021),革兰阳性球菌占45.7%(924/2 021),真菌占6.9%(139/2 021)。耐甲氧西林金黄色葡菌球菌(MRSA)和耐甲氧西林血浆凝固酶阴性葡萄球菌(MRCNS)平均检出率分别为26.9%(50/186)和82.3%(466/566)。大肠埃希菌产ESBLs菌株2012年阳性率最高,为50.0%(33/66);肺炎克雷伯菌产ESBLs菌株2012年阳性率最高,为20.8%(10/48)。结论近年来泛耐药鲍曼不动杆菌和铜绿假单胞菌的检出率增高明显,汇总血液标本的资料并及时分析细菌谱及耐药谱的变化对指导临床合理用药及预防细菌耐药的发生有重要的参考意义。

Objective To investigate the bacterial spectrum and drug resistance in the blood samples from the patients inHainan Provincial Nongken General Hospital duing the period from Janurary 2010 to December 2014,in order to provide thebasis for treatment of infectious diseases and rational use of antibiotics. Methods A retrospective study was carried on the 2021 bacterial strains isolated from the above-mentioned blood samples. The drug resistance rates of these pathogenic bacteriawere analyzed. Results Besides Coagulase- negative staphylococci（CNS）,the most common bacteria were Klebsiellapneumoniae in 2010,but Escherichia coli took in the first place during 2011 and 2014. The positive rate of blood bacteriainfection was 6.3%（2 021/32 300）. Among the 2 021 bacterial stains in the 5 years,Gram-negative bacilli occupied 47.4%（958/2 021）,Gram-positive 45.7%（924/2 021）,while fungi accounted for 6.9%（139/2 021）. The average detection rate ofMethicillin- resistant Staphylococcus aureus（MRSA）was 26.9%（50/186）,and that of Methicillin- resistant Coagulase-negative staphylococcus（MRCNS）was 82.3%（466/566）. The positive rate of ESBLs producing strains of Escherichia coli washighest in 2012,for 50.0%（33/66）; The positive rate of ESBLs producing strains of Klebsiella pneumoniae was highest in2012,for 20.8%（10/48）. Conclusion The detection rates of Pan-drug resistant Acinetobacter baumanii and Pseudomonasaeruginosa were increased obviously,it is of important significance for reference of collecting the data of blood samples andanalyzing the changes of bacterial spectrum and drug resistance in time in guidance of clinical rational use of antibiotics andprevention of bacterial resistance.