2010—2014年血培养分离菌的分布及耐药性分析

The distribution and antibiotic resistance of clinical isolates from blood culture:a five-year analysis from 2010 to 2014

目的了解2010-2014年安徽省铜陵市人民医院血培养分离菌的分布及其对常用抗菌药物的耐药情况。方法所有血培养分离菌用纸片法进行抗菌药物敏感试验。应用WHONET 5.6软件进行统计分析。结果共分离各类病原菌871株（剔除重复菌株）,其中革兰阳性菌占51.8%（451株）,革兰阴性菌占47.0%（409株）,真菌占1.3%（11株）。居前6位的分离菌依次为凝固酶阴性葡萄球菌（31.5%）、大肠埃希菌（17.8%）、肺炎克雷伯菌（9.9%）、不动杆菌属（6.3%）、肠球菌属（5.9%）和金黄色葡萄球菌（金葡菌）（4.9%）。甲氧西林耐药金葡菌（MRSA）和凝固酶阴性葡萄球菌（MRCNS）分别占各自菌的37.2%和60.6%。未发现耐万古霉素和替考拉宁葡萄球菌;粪肠球菌对青霉素、氨苄西林的耐药率较低;未发现耐万古霉素和替考拉宁粪肠球菌和屎肠球菌。大肠埃希菌和肺炎克雷伯菌中产ESBL株分别占43.2%和29.1%;大肠埃希菌对阿米卡星、头孢西丁、头孢哌酮-舒巴坦、哌拉西林-他唑巴坦耐药率在10%以下,肺炎克雷伯菌对阿米卡星、环丙沙星、头孢西丁、头孢吡肟耐药率在20%以下;出现对碳青霉烯类耐药的肠杆菌科细菌（CRE）,大肠埃希菌对碳青霉烯类耐药率在1%以下,但肺炎克雷伯菌对碳青霉烯类耐药率达20.8%-22.4%。不动杆菌属细菌耐药现象严重,仅对替加环素尚无耐药,对米诺环素、头孢哌酮-舒巴坦和阿米卡星耐药率分别为33.3%、34.2%和44.7%,对其他抗菌药物耐药率均在70%以上。结论血培养分离菌仍以革兰阳性菌为主,凝固酶阴性葡萄球菌和大肠埃希菌是血液标本中最常见的临床分离菌,肺炎克雷伯菌对碳青霉烯类的耐药率呈上升趋势。应重视血培养分离菌的耐药性监测,加强抗生素的合理使用和医院感染控制。

Objective To investigate the distribution and antibiotic resistance of clinical isolates from blood culture from 2010to 2014.Methods The susceptibility of blood culture isolates to commonly used antimicrobial agents were determined by KirbyBauer method.All the data were analyzed by using WHONET 5.6 software.Results A total of 871 strains were isolated from blood samples from 2010 to 2014,of which gram positive cocci,gram negative bacilli and fungi accounted for 51.8%（451/871）,47.0%（409/871）and 1.3%（11/871）,respectively.The top six bacterial species were coagulase-negative Staphylococcus（CNS）（31.5%）,E.coli（17.8%）,K.pneumoniae（9.9%）,Acinetobacter（6.3%）,Enterococcus（5.9%）and S.aureus（4.9%）.MRSA accounted for 37.2%of S.aureus and MRCNS accounted for 60.6%of the CNS strains.The resistance rate to penicillin,ampicillin was low in E.faecalis.No strains were found resistant to vancomycin or teicoplanin in Staphylococcus spp.,E.faecalis and E.faecium.About 43.2%of the E.coli isolates and 29.1%of the K.pneumoniae isolates produced extended-spectrumβ-lactamases（ESBLs）.E.coli isolates displayed low resistance rate（〈10.0%）to amikacin,cefoxitin,cefoperazone-sulbactam,and piperacillin-tazobactam.Less than 20%of the K.pneumoniae isolates were resistant to amikacin,ciprofloxacin,cefoxitin and cefepime.Carbapenemresistant Enterobacteriaceae（CRE）strains were identified.Less than 1%of the E.coli isolates were resistant to carbapenem,but there were about 20.8%to 22.4%of K.pneumoniae isolates were resistant to carbapenems.Acinetobacter isolates were highly resistant（〉70%resistant）to commonly used antibiotics except minocycline,cefoperazone-sulbactam and amikacin,to which 33.3%,34.2%and 44.7%,respectively.No tigecycline-resistant strains of Acinetobacter spp.were found.Conclusions Our five-year surveillance data indicated that gram positive cocci still play an important role in blood stream infections.CNS and E.coli were the most common pathogens.K.pneumoniae strains from blood samples showed increasing resistance rate to carbapenems.We should pay more attention to resistance surveillance and the rational use of antibiotics.