恶性肿瘤患者血培养菌群分布及耐药性分析

Analysis of distribution and drug resistance of blood culture bacteria in patients with malignant tumor

目的:通过整理和分析血流感染患者病原菌的构成、分布及耐药特点,为临床血流感染的诊治及抗菌药物的合理应用提供重要依据。方法:分析2014年至2015年2 287份血培养标本,采用BACT/ALERT 3D60血培养仪,运用ATB Expression微生物鉴定及药敏分析仪进行病原菌鉴定及药敏试验。结果:本次调查的2 287份血培养标本中共检出阳性标本258份,检出率为11.28%。其中,革兰阳性菌占35.52%,革兰阴性菌占61.78%,真菌占1.93%,专性厌氧菌占0.77%。耐甲氧西林金黄色葡萄球菌(MRSA)占22.73%(5/22),耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)占63.27%(31/49),大肠埃希菌、肺炎克雷伯菌对亚胺培南、美罗培南敏感率100%,而对阿莫西林、替卡西林、哌拉西林及头孢类抗菌药物有较高的耐药性。结论:引起血流感染的病原菌以革兰阴性菌为主,临床应及时了解病原菌的分布及药敏的监测,可以选择更有效的抗菌药物,从而减少耐药菌株的产生。

Objective：To provide an important basis for clinical diagnosis,treatment and rational use of antimicrobial agents,the composition,distribution and drug resistance of pathogenic bacteria in hospital from 2014 to 2015.Methods：The data of 2 287 blood culture samples were analyzed used BACT/ALERT 3D 60 blood culture instrument,used Expression ATB microbial identification and drug sensitivity analysis of pathogenic bacteria identification and drug sensitivity test.Results：2 287 blood samples were detected in 258 samples of blood culture,the positive rate was 11.28%.Among them,gram positive bacteria accounted for 35.52%,gram negative bacteria accounted for 61.78%,fungi accounted for 1.93%,special anaerobic bacteria accounted for 0.77%.Resistance of methicillin-resistant Staphylococcus aureus （MRSA） [22.73%（5/22）] and resistant to methicillin resistant coagulase negative staphylococci （MRCNS） 63.27%（31/49）,Escherichia coli,pneumonia Klebsiella pneumoniae strains to imipenem,meropenem sensitive rate were 100%,and amoxicillin,ticarcillin,piperacillin,pull penicillin and cephalosporin class antimicrobial drugs had higher.Conclusion：The main pathogens of bloodstream infections are Gram-negative bacteria,which could be used to understand the distribution of pathogenic bacteria and the monitoring of drug sensitivity in a timely manner,so as to select more effective antimicrobial agents,and to reduce the production of drug resistant strains.