摘要
目的回顾性分析本院2013年-2016年血培养阳性检出的病原菌分布特征及抗生素耐药情况,为血流感染者的诊断和治疗提供参考依据。方法选取本院住院患者无菌抽取的血液标本,采用BD全自动血培养仪进行培养。采用VITEK 2 Compact全自动微生物分析系统及配套的细菌鉴定卡,真菌药敏采用ATB Fungus 3药敏试验条进行药敏试验。结果 7 661份血培养标本共分离出非重复病原菌868株,检出率为11.3%,其中革兰阴性杆菌占46.9%,革兰阳性球菌占44.5%,真菌占8.6%;占比前4位的细菌依次为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌。碳青霉烯类耐药肺炎克雷伯菌(CRKP)占比达16.2%,碳青霉烯类耐药铜绿假单胞菌(CRPA)占15.5%。耐甲氧西林金黄色葡萄球菌(MRSA)检出率为50.9%。结论本院血流感染以革兰阴性杆菌为主,真菌的血流感染不容忽视。万古霉素、喹努普汀/达福普汀和利奈唑胺可作为治疗葡萄球菌所致血流感染重症患者的首选用药。临床医生应高度重视早期血培养,合理使用抗菌药物,有效减少耐药菌株的产生。
Objective To analyze the distribution and drug resistance of pathogen in the Second Affiliated Hospital of Nanjing Medical University during 2013-2016,so as to provide refference for the diagnosis and treatment of bloodstream infection.Methods Blood samples taken from the hospitalized patients were selected and cultured by BD automatic blood culture instrument. VITEK 2 Compact automatic microbial analysis system and the supporting bacterial identification card were adopted.Fungal sensitivity test was carried out using the ATB Fungus 3 susceptibility test strip. Results A total of 868 pathogens were isolated from 7 661 blood culture samples and the positive rate was 11. 3%,including 46. 9% strains of Gram-negative bacilli,44. 5% strains of Gram-positive coccus,8. 6% strains of Fungi. E. coli,Klebsiella pneumonia,Pseudomonas aeruginosa and Staphylococcus aureus were the top four pathogenic bacteria in bloodstream infection. The carbapenem resistant Klebsiella pneumoniae( CRKP) accounted for 16. 2%,carbapenem resistant Pseudomonas aeruginosa( CRPA) accounted for 15. 5%,and methicillin resistant Staphylococcus aureus( MRSA) accounted for 50. 9%. Conclusion The bloodstream infection is mainly caused by Gram-negative bacilli,and the infection caused by Fungi can not be ignored. Vancomycin,quinupristin/dalfopridin and linezolid can be used as the first choice for treating patients with severe bloodstream infection caused by Staphylococcus aureus. Clinicians should attach great importance to early blood culture,rational use of antibacterial drugs,so as to effectively reduce drug-resistant strains.
作者
赵艳丰
赵水娣
徐新艳
胡慧敏
ZHAO Yan-feng;ZHAO Shui-di;XU Xin-yan;HU Hui-min(Clinical Laboratory,the Second Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210011,China)
出处
《中国卫生检验杂志》
CAS
2018年第17期2049-2052,共4页
Chinese Journal of Health Laboratory Technology
基金
南京市医学科技发展项目(YKK13175)
关键词
血培养
血流感染
病原菌
耐药性
Blood culture
Bloodstream infection
Pathogenic bacteria
Drug resistance