住院患者血流感染病原菌的种类与耐药性分析

Species and drug resistance of pathogens causing bloodstream infections in hospitalized patients

目的：了解该地区临床血流感染病原菌的流行病学情况及病原菌耐药率，为临床防控与治疗菌血症提供依据。方法收集2014-2015年常熟地区综合医院血液培养标本，Bact ALERT 3D 血培养仪进行培养，阳性结果以 VITEK 2 compact 细菌鉴定及药敏分析仪进行菌种鉴定与抗菌药物敏感性分析，数据经WHONET 细菌管理软件进行处理，参照2014年药敏标准进行分析。结果送检标本16751份，阳性结果893株，阳性率5．3％。其中革兰阳性菌423株，占47．4％，分别为凝固酶阴性葡萄球菌（62．9％）、金黄色葡萄球菌（8.6％）、肠球菌属（13．8％）；革兰阴性菌419株，占46．9％，前五位分别为大肠埃希菌（47．0％）、肺炎克雷伯菌（16．5％）、铜绿假单胞菌（4．9％）、嗜麦芽窄食假单胞菌（4．5％）、洋葱伯克霍尔德菌（3．8％）；真菌类检出率占5．7％，为白假丝酵母（76．5％），热带假丝酵母（23．5％）。超广谱β-内酰胺酶菌株检出率为56．0％，耐甲氧西林金黄色葡萄球菌检出率为25．0％，耐甲氧西林凝固酶阴性葡萄球菌为67．8％，肠杆菌科细菌对碳青酶烯类药物保持高度敏感，耐碳青霉烯类肠杆菌科检出率为0．0％。革兰阳性菌中未发现万古霉素、利奈唑烷和奎奴普丁／达福普汀等不敏感的葡萄球菌，未检出耐万古霉素肠球菌。结论血流感染病原菌种类多样，凝固酶阴性葡萄球菌检出率高。耐药率多数处于较低位置，但非发酵类多重耐药菌株仍会造成严重感染，要不断加强耐药菌的监测与抗生素的合理使用。

Objective To investigate the distribution and resistance of positive pathogens isolated from blood culture and guide the use of antibiotics for clinical treatment and prevention treatment of bacteremia.Methods Collected the blood samples from 201 4 to 201 5 and cultivate by Bact ALERT 3D,pathogenic bacteria identification and antimicrobial susceptibility testing was carried out by VITEK 2 compact.The bacterial data were analyzed by WHONET 5.6 software,according to the breakpoints of CLSI 2014.Results Among the 16 751 blood culture samples, 893 cases showed positive and the positive rate was 5.3%.Among the strains,the percentage of the gram -positive bacteria was 423,including coagulase -negative Staphylococcus （62.9%）,S.aureus （8.6%）,Enterococcus （1 3.8%）;the percentage of the gram -negative bacteria was 41 9,including Escherichia coli（47.0%）,Klebsiella pneumonia（1 6.5%）,Pseudomonas aeruginosa（4.9%）,Stenotrophomonas maltophilia（4.5%）and Brukhoderial. cepacia（3.8%）;the percentage of fungi was 5.7%,including Candida albicans（76.5%）and candida parapsilosis （23.5%）.The prevalence of ESBLs producing strains was 56.0% in E.coli and K.pneumoniae.The average prevalence of methicillin -resistant strains in S.aureus（MRSA）and coagulase -negative Staphylococcus（MRCNS） was 25.0% and 67.8% respectively.Enterobacteriaceae strains were still highly susceptible to the carbapenem drug. The rate of CRE was zero.The resistance to vancomycin,linezolid and quinupristin/Dafoe leptin was not found in Staphylococcus.VRE was not found.Conclusion There was a variety of pathogens leading to bloodstream infection which show a relative sensitive resistance to many antimicrobial agents.Meanwhile,the multi -drug resistant strains may have serious consequences,and the monitoring and rational use of antibiotics should be strengthened.