2015年临床血流感染病原菌分布及耐药性分析

Characteristics of distribution and antibiotic resistance analysis of bloodstream infection bacteria in 2015

目的了解本院血流感染患者的病原菌种类及耐药特点,为其治疗提供依据。方法收集浙江省人民医院2015年1月-12月门诊及住院患者血培养阳性结果,分析血流感染患者临床资料、病原菌种类及药物敏感性试验资料。结果本研究共统计分析血培养阳性病原菌458株,其中革兰阴性杆菌占56.1%;革兰阳性球菌占42.4%;真菌占1.5%。病原菌分离率居首位的是凝固酶阴性葡萄球菌,占31.0%,其次为大肠埃希菌(19.7%)、肺炎克雷伯菌(16.8%)、鲍曼不动杆菌(5.8%)。耐甲氧西林的金黄色葡萄球菌(MRSA)和凝固酶阴性葡萄球菌(MRCNS)分离率分别为55.0%和54.6%。产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌检出率分别为46.7%和27.3%。血流感染的鲍曼不动杆菌对亚胺培南耐药率为40.7%,对替加环素耐药率为11.1%。铜绿假单胞菌对亚胺培南耐药率为33.3%,对氨基糖苷类药物具有高敏感性。结论本院血流感染病原菌以革兰阴性杆菌为主。了解血流感染患者病原菌分布及耐药特点,有助于临床抗菌药物经验性应用。

Objective To analyze the types and antibiotic resistance of bloodstream infection bacteria in 2015.Methods The bloodstream infection bacteria were isolated from Zhejiang Provincial People＇s Hospital during January-December in 2015.Clinical data, pathogenic bacteria classes and antimicrobial susceptibility testing were further retrospectively analyzed.Results In this study,a total of 458 isolates of pathogenic bacteria were isolated from blood culture,including Gram negative bacilli（56.1%）,positive Cocci（42.4%） and Fungus（1.5%）.Coagulase-negative Staphylococcus（31.0%） was the most common bacteria,followed by Escherichia coli（19.7%）,Klebsiellapneumonia（16.8%）,Acinetobacter baumannii（5.8%）.The rate of methicillin-resistant S.aureus and coagulase-negative Staphylococcus were 55.0% and 54.6%,respectively.In addition,46.7% of the E.coli isolates and 27.3% of the K.pneumoniae isolates carried extended-spectrum beta-lactamases.40.7% of A.baumannii strains were resistant to imipenem,and 11.1% strains displayed resistance to tigecycline.The rate of Pseudomonas aeruginosa strains resistant to imipenem was 33.3% and showed high susceptibility to aminoglycoside antibiotics.Conclusion Gram negative bacteria is the main pathogen in the blood cultures in our hospital.The distribution and resistant profile of these pathogens are helpful for providing basis for the experimental application of antibiotics.