医院血培养常见病原菌的耐药性分析

Distribution of pathogenic bacteria and their drug resistance in blood culture in hospital

目的调查住院患者血培养常见病原菌分布及耐药性,为临床抗菌药物合理使用提供依据。方法采用法国梅里埃公司BACT/ALERT 3D全自动血培养仪对2014年6月-2016年12月某三级甲等医院血培养标本进行鉴定,西门子WalkAway 96Plus全自动微生物鉴定和药敏试验分析系统对细菌进行鉴定和耐药性分析。结果共检出病原菌1 027株,病原菌以革兰阴性菌为主,共650株占63.29%;大肠埃希菌、肺炎克雷伯菌对氨苄西林的耐药率较高,均>85.00%;鲍氏不动杆菌对哌拉西林、头孢菌素类、氨基糖苷类和亚胺培南等耐药率均较高>60.0%,铜绿假单胞菌对大部分抗菌药的耐药率较低,<30.00%,金黄色葡萄球菌对氨苄西林的耐药率达96.7%。结论血培养病原菌以革兰阴性菌为主,应加强对可引起血流感染的细菌耐药监测,指导临床合理使用抗菌药物,对控制医院感染具有重要意义。

OBJECTIVE To investigate the distribution of pathogenic bacteria and their drug resistance in positive blood culture specimens from inpatients in a tertiary first-class hospital,so as to provide reference basis for the clinical rational use of antimicrobial agents.METHODS BacT/Alert 3D automated blood culture system（BioMerieux,France）was used to identify blood culture specimens in a tertiary first-class hospital from Jun.2014 to Dec.2016.The bacteria identification and drug resistance analysis were performed by using the MicroSan Walk/Away-96 Plus automatic microbial identificaition and drug susceptility test analysis system（Siemens,Germany）.RESULTS A total of 1027 isolates were detected,and the main pathogens were gram-negative bacteria,which were650 strains accounting for 63.29%.The drug resistant rates of Escherichia coli and Klebsiella pneumoniato ambicillin were high,which were higher than 85.00%.The average drug resistant rates of Acinetobacter baumannii to piperacillin,cephalosporins,aminoglycoside and imipenem were high.Pseudomonas aeruginosa showed low resistant rates to most of drugs,which were all below 30%.Staphylococcus aureus drug resistant rate to ambicillin reached 96.7%.CONCLUSIONThe main pathogens of blood culture are gram-negative bacteria.It is of great significance to strengthen the monitoring of drug resistance of bacteria that can cause bloodstream infections,and to guide the rational use of antibiotics in clinic,for the control of nosocomial infections.