血流感染病原菌分布及其体外药物敏感性试验结果分析

Distribution of pathogens causing bloodstream infection and in vitro drug susceptibility test result analysis

目的了解引起上海市浦东新区公利医院住院患者血流感染的病原菌分布特征及其耐药性,为临床选择有效的抗菌药物治疗血流感染提供参考依据。方法收集2012年7月至2015年6月上海市浦东新区公利医院住院患者血流感染时分离的病原菌380株,采用VITEK2 Compact全自动微生物分析系统进行细菌鉴定及药物敏感性试验,并使用WHONET 5.6软件对结果进行分析。结果革兰阳性球菌157株,占41.3%,以凝固酶阴性葡萄球菌、金黄色葡萄球菌和肠球菌为主;需氧革兰阴性杆菌203株,占53.4%,以大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌为主;念珠菌20株,占5.3%,以白念珠菌为主。金黄色葡萄球菌对苯唑西林的耐药率为47.6%,铜绿假单胞菌和鲍曼不动杆菌对亚胺培南的耐药率分别23.1%和36.4%,大肠埃希菌和肺炎克雷伯菌对厄他培南的耐药率分别为0.0%和11.1%,白念珠菌对氟康唑的耐药率为30.8%。结论凝固酶阴性葡萄球菌和大肠埃希菌是引起上海市浦东新区公利医院住院患者血流感染的最常见病原菌,所分离的细菌耐药率较高,临床应重视抗菌药物的合理使用。

Objective To understand the distribution characteristic and drug resistance of pathogens in patients with bloodstream infection from Shanghai Pudong Gongli Hospital,and to provide a reference on the choice of antimicrobial agents for treatment.Methods A total of 380 pathogens were isolated from inpatients with bloodstream infection in Shanghai Pudong Gongli Hospital from July 2012 to June 2015,and were identified using VITEK2 Compact automated microorganism analysis system. Drug susceptibility test was performed by VITEK2 Compact. The data were analyzed by WHONET 5.6 software.Results There were 157 isolates of Gram-positivecocci,accounted for 41.3%. Coagulase-negativeStaphylococcus,Staphylococcusaureus andEnterococcus were main Gram-positive cocci. A total of 203 isolates of Gram-negativebacilli were isolated and identified,accounted for 53.4%,and Escherichia coli,Klebsiella pneumoniae andPseudomonas aeruginosa were main Gram-negativebacilli. There were 20 isolates ofCandida,andCandida albicans was common. The drug resistance rate ofStaphylococcus aureus to oxacillin was 47.6%. The drug resistance rates ofPseudomonas aeruginosa and Acinetobacter baumannii to imipenem were 23.1% and 36.4%,and those ofEscherichia coli andKlebsiella pneumoniae to ertapenem were 0.0% and 11.1%. The drug resistance rate ofCandida albicans tofluconazole was 30.8%.Conclusions Coagulase-negative Staphylococcus andEscherichia coli are the most common pathogens causing bloodstream infection with high drug resistance rates. It should pay more attention to the rational use of antimicrobial agents.