2011-2016年我院1775株血流感染病原菌构成及其耐药性分析

Distribution of 1775 Strains of Bloodstream Infection Pathogens and Analysis of Drug Resistance in Our Hospital during 2011-2016

目的:为临床合理使用抗菌药物提供参考。方法:收集我院2011年1月-2016年12月住院患者的血培养阳性标本,回顾性分析我院血液感染(BSI)病原菌分布及耐药情况。结果:2011-2016年,我院住院患者共送检血培养标本26 034份,其中阳性标本1 775份,总阳性率为6.82%;主要来源于肿瘤、血液科(10.65%),神经外科(8.28%)和儿科(8.00%)。共检出病原菌1 775株,包括以大肠埃希菌、肺炎克雷伯菌为主的革兰氏阴性菌967株(54.48%),以凝固酶阴性葡萄球菌、金黄色葡萄球菌为主的革兰氏阳性菌649株(36.56%)和以白色念珠菌为主的真菌159株(8.96%)。大肠埃希菌和肺炎克雷伯菌对常用抗菌药物均存在不同程度的耐药性,但对哌拉西林钠他唑巴坦钠、亚胺培南、美罗培南较敏感;鲍曼不动杆菌对含酶抑制剂类、头孢菌素类、氨基糖苷类、喹诺酮类药物的耐药率均较高;铜绿假单胞菌对第三代头孢菌素类、氨基糖苷类、喹诺酮类药物较敏感。金黄色葡萄球菌对青霉素类、头孢菌素类、氨基糖苷类药物的耐药率较高;凝固酶阴性葡萄球菌对大部分常用抗菌药物的耐药率均超过40%;但两者对利奈唑胺、万古霉素敏感,耐药率均为0。共检出产超广谱β-内酰胺酶(ESBLs)大肠埃希菌205株(42.01%)、产ESBLs肺炎克雷伯菌64株(30.33%)、耐甲氧西林金黄色葡萄球菌31株(17.61%);未检出耐万古霉素肠球菌和耐万古霉素金黄色葡萄球菌。结论:我院BSI病原菌主要分布在肿瘤、血液科等科室,以肠杆菌科细菌、葡萄球菌为主,真菌也占一定比例,其耐药及产酶情况不容乐观。对主要病原菌较敏感的抗菌药物包括碳青霉烯类、利奈唑胺和万古霉素等。

OBJECTIVE： To provide reference for rational use of antibiotics in the clinic. METHODS： Blood culture positive specimens were collected from our hospital during Jan. 2011-Dec.2016. Distribution of bloodstream infection （BSI） pathogens and drug resistance were analyzed in our hospital retrospectively. RESULTS： During 2011-2016, 26 034 blood culture specimens isolat- ed from inpatients of our hospital were examined, including 1 775 positive specimens with positive rate of 6.82%. The specimens mainly came from tumor hematology department （10.65%）, neurosurgery department （8.28%） and pediatric department （8.00%）. A total of 1 775 strains of pathogens were detected, including 967 strains of Gram-negative bacteria （54.48%） mainly as Escherichia coli, Klebsiella pneumoniae, 649 strains of Gram-positive bacteria （36.56%） mainly as Coagulase negative Staphylococci, Staphylococcus aureus and 159 strains of fungus （8.96%） mainly as Candida albicans. E. coli and K. pneumoniae were resistant to common antibiotics to different extents, but sensitive to piperacillin sodium and tazobactam sodium, imipenem, meropenem. Acinetobacter baumanii was highly resistant to enzyme inhibitors, cephalosporins, aminoglycosides, quinolones. Pseudomonas aerugi- nosa was sensitive to third-generation cephalosporins, aminoglycosides and quinolones. S. aureus was highly resistant to penicil- lins, cephalosporins and aminoglycosides. Resistance rate of Coagulase negative Staphylococci to most commonly used antibiotics was higher than 40%. Above two bacteria were sensitive to linezolid and vancomycin with resistance rate of 0. A total of 205 strains of ESBLs-producing E. coli （42.01%）, 64 strains of ESBLs-producing K. pneumoniae （30.33%） and 31 strains of Methicil- lin-resistant S. aureus （17.61% ） were detected. No vancomycin-resistant Enterococcus or vancomycin-resistant S. aureus was detect- ed. CONCLUSIONS： BSI pathogens mainly distribute in tumor hematology department of our hospital. BSI pathogens mainly in- elude Enterobacteriaceae and Staphylococcus, and also involve fungus. The situation of drug resistance and enzyme production are not optimistic. Antibiotics, which are sensitive to the major pathogens, include carbapenems, linezolid and vancomycin.