2008—2014年中国南方某综合性医院血流感染病原菌构成及耐药性分析

Analysis on distribution and drug resistance of bacteria causing bloodstre am infections in a general hospital of South China from 2008 to 2014

目的了解福州地区血流感染病原菌分布及耐药状况,为临床合理应用抗菌药物提供依据。方法回顾性分析本医院2008年1月—2014年12月临床送检的血培养标本病原菌构成及耐药性。药物敏感性试验采用MIC或KB纸片法,按CLSI规定的标准执行;应用WHONET5.6软件分析病原菌的种类及耐药状况。结果 7年间从临床送检的血培养标本中共培养分离获得4292株病原菌,其中革兰阴性菌2667株(占62.14%),革兰阳性菌1353株(占31.52%),真菌272株(占6.34%)。排前三位的病原菌为大肠埃希菌、凝固酶阴性葡萄球菌和肺炎克雷伯菌。主要来源的科室为血液科、重症医学科和门诊患者。产ESBLs的大肠埃希菌和肺炎克雷伯菌平均检出率分别为57.46%和24.77%,对亚胺培南的耐药率:肺炎克雷伯菌为7.98%并呈上升趋势,阴沟肠杆菌为9.58%,铜绿假单胞菌为23.66%,鲍曼不动杆菌为38.10%。耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)和金黄色葡萄球菌(MRSA)检出率分别为81.00%和38.60%;未发现对万古霉素、利奈唑胺及替加环素耐药的葡萄球菌。粪肠球菌和屎肠球菌对万古霉素的耐药率分别为0.66%和5.21%。结论本地区血流感染病原菌以革兰阴性菌为主,但应重视真菌的感染,针对性的合理使用抗菌药物。

Objective To investigate the distribution and antimicrobial resistance of microorganisms isolated from bloodstream infections in Fuzhou, and to provide evidence for the clinical therapy. Methods Using the retrospective analysis, distribution and drug resistance of bacteria which had caused bloodstream infections from Jan. 2008 to Dec. 2014 were analyzed. The minimum inhibitory concentration （MIC）and K-B method were used for the antibiotics susceptibility test. The data was analyzed by WHONET 5.6. Results A total of 4,292 strains of pathogenic bacteria were collected in 7 years. The main isolated bacteria were Escherichia coli, coagulase negative Staphylococcus and Klebsierlla pneumoniae. The hematological department, intensive care unit and outpatient department were the three main departments. The extended-spectrum β-lactamases （ESBLs） positive rates of Escherichia coli and Klebsiella pneumoniae were 57.46% and 24.77% respectively. Resistant rate of imipenem on K. pneumonia was 7.98% and increasing quickly. Resistant rates of Enterobacter cloacae, P. aeruginosa and A.baumannii were 9.58%, 23.66% and 38.10%, respectively. The meticillin-resistant incidences of coagulase negative Staphylococcus （MRCNS） and Staphylococcus aureus （MRSA） were 81.00% and 38.60%, respectively. No resistant strains of Staphylococcus were found for vancomycin, linezolid and tigecycline. The resistant rates of vancomycin on E. faecalis and E. faecium were 0.66% and 5.21%, respectively. Conclusion The majority of pathogenic bacterias which caused bloodstream infections were negative bacteria. However, fungal infection should be taken more seriously. Moreover, antimicrobial drugs should be reasonably used in the clinical treatment.