2012-2016年宁夏某医院临床分离血流感染病原菌分布及耐药趋势分析

Distribution and Drug Resistance Trend of Pathogens in Clinical Isolated Bloodstream Infection in A Hospital of Ningxia in 2012-2016

目的了解血流感染病原菌的分布变化及常见细菌耐药趋势,为临床及时正确的诊断和治疗提供参考。方法采用BacT/Alert3D全自动血培养仪对本院2012年1月至2016年12月18543份血液标本进行培养,用VITEK-2 Compact全自动微生物分析系统对血培养分离的细菌及真菌进行鉴定,用K-B法进行药敏实验。结果 18543份血液标本中培养出病原菌共1706株,阳性率为9.3%,其中革兰阴性菌955株(56.0%),革兰阳性菌720株(42.2%),真菌31株(1.8%)。分离前5位的病原菌为凝固酶阴性葡萄球菌(CNS)432株(25.3%)、大肠埃希菌371株(21.7%)、布鲁菌属262株(15.4%)、克雷伯菌128株(7.5%)、金黄色葡萄球菌(SAU)101株(5.9%)。5年间革兰阴性杆菌的检出率逐年升高,从43.8%升高到56.0%,尤其是布鲁菌的检出率升高,从7.6%最高上升到21.4%,病原菌主要分布在ICU、儿科、感染科、呼吸科、肾内科和骨科等临床科室。结论本院血流感染革兰阴性菌检出率逐年增高,特别是布鲁菌的检出率增高明显;临床应提高血培养检测意识,规范血培养的采集,以减少血流感染引起的并发症和病死率。

Objective This study aims to investigate the distribution of pathogens in bloodstream infection and the trend of common bacterial drug resistance in order to provide reference for clinical timely and correct diagnosis and treatment. Methods 18543 blood samples were cultured from Bac T/Alert3D automatic biopsy system from January 2012 to December 2016,and the bacteria and fungi isolated from blood culture were identified by VITEK-2 compact automatic microbiological analysis system. K-B method was used for drug susceptibility testing. Results A total of 1706 strains of pathogens were isolated from18543 specimens,with a positive rate of 9.3%. Specifically,with 955 strains of Gram-negative bacteria（56.0%）,720 strains of Gram-positive bacteria（42.2%）,31 strains of fungi（1.8%）. The top five most common pathogens were CNS（n=432,25.3%）,Escherichia coli（n=371,21.7%）,Brucella（n=262,15.4%）,Klebsiella pneumoniae（n=128,7.6%）and Staphylococcus aureus（n=101,5.9%）. During the 5 years,the detection rate of gram-negative bacteria increased from 43.8% to 56.0%,especially the detection rate of Brucella increased significantly from 7.6% to 21.4%. Pathogenic bacteria are mainly distributed in ICU,Pediatrics,infectious diseases,Department of respiration,Nephrology and Department of orthopedics.Conclusion The detection rate of gram-negative bacteria in bloodstream infection in our hospital is increasing year by year. We should pay attention to the infection of Brucella in the area. The clinical awareness of blood culture should be improved and the blood culture should be standardly collected in order to diagnose and reduce the complications and mortality caused by bloodstream infection.