2015-2017年巴彦淖尔市医院血培养病原菌分布及耐药性分析

Analysis of the distribution and drug resistance of pathogenic bacteria by blood culture in Bayannur hospital during 2015-2017

目的:了解巴彦淖尔市医院2015-2017年血培养病原菌的分布及耐药情况。方法:对1 931例患者送检血培养标本采用BACT/ALERT3D血培养仪进行血液培养,运用VITEK2-compact全自动分析仪进行菌种鉴定和药敏试验,部分药敏用纸片法测试。结果:共分离280株病原菌,阳性率为14.5%;其中革兰阴性菌占63.6%,革兰阳性菌占33.6%,真菌占2.8%。检出率居前五位的菌株依次为大肠埃希菌、凝固酶阴性葡萄球菌、肺炎克雷伯菌、马耳他布鲁氏菌、阴沟肠杆菌。产超广谱β-内酰胺酶(ESBL)大肠埃希菌和肺炎克雷伯菌分别为56.8%和12.1%,碳青霉烯类对大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌等有较高的抗菌活性。鲍曼不动杆菌大多为多重耐药菌。耐甲氧西林金葡菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)在金葡菌和凝固酶阴性葡萄球菌中的检出率为12.0%和75.6%。未发现耐万古霉素的葡萄球菌。结论:血培养病原菌耐药率较高,加强血培养病原菌耐药性监测对血流感染的治疗十分必要。

Objective：To investigate the distribution and drug resistance of pathogenic bacteria by blood culture in Bayannur Hospital during 2015 -2017. Methods： BACT/ALERT3 D was adopted for blood culture of the blood samples from 1931 cases of patients; VITEK2 - compact was adopted for identification and drug resistance test; Paper disk method was used for part of drug sensitivity tests. Results：280 strains were isolated from 1931 samples, with the positive rate at 14.5%. Among them the gram - negative bacteria were 63.7 %, the gram - positive bacteria were 33.6 %, and the fungus was in 2.8 %. The top five detection rates were Escherichia coli, Coagulase negative staphylococcus, Klebsiella pneu- moniae, Alcaligenes melitensis and Enterobacter cloacae. The Extended Spectrum Lactamase （ESBL） of Escherichia coli and Klebsiella pneumoni- ae were 56.8 % and 12.1% respectively. The sensitivity of carbopenems to Enterobacter cloacae, Escherichia coli and Klebsiella pneumoniae were higher. Most of the Acinetobacter Baumannii was muhidrug resistant bacteria. The isolation rate of methicillin resistant staphylococcus aureus （MRSA） and methicillin resistant Coagulase negative staphylococcus （MRCNS） were 12 % and 75.6 % in staphylococcus aureus and Coagulase negative staphylococcus. No VRSA strains were found. Conclusions ： Drug - resistance rate of pathogenic bacteria from blood culture was higher. More attention should be paid to drug resistance of pathogenic bacteria from the blood culture, and it is necessary for the treatment of bloodstream infection.