宁夏某医院2016年血培养病原菌分布与耐药性分析

Analysis on distribution and drug resistance of pathogenic bacteria from blood culture in a hospital of Ningxia during 2016

目的了解该地区血流感染病原菌的分布与耐药性,为临床合理用药提供参考依据。方法采用回顾性调查方法,对2016年1-12月该院门、急诊及住院患者送检血培养标本分离的主要病原菌及耐药性进行分析。血培养标本采用Bact/Alert 3D全自动血培养仪进行培养检测,采用VITEK-2Compact全自动微生物鉴定系统进行病原菌的鉴定和药敏试验。结果共检出病原菌882株,其中革兰阴性菌607株,占68.82%;革兰阳性菌221株,占25.06%;真菌23株,占2.61%;厌氧菌31株,占3.51%。临床血流感染前5位病原菌依次为大肠埃希菌(32.54%)、肺炎克雷伯菌(12.05%)、羊种布鲁菌(8.05%)、金黄色葡萄球菌(7.48%)、屎肠球菌(4.99%)。耐甲氧西林金黄色葡萄球菌检出率为13.41%,未发现对万古霉素、替考拉宁耐药的革兰阳性菌;大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌等肠杆菌科细菌对头孢呋辛和头孢曲松的耐药率较高,同时存在大肠埃希菌对亚胺培南耐药的情况,耐药率为2.40%;鲍曼不动杆菌对多数临床常用抗菌药物耐药率较高,仅对米诺环素和阿米卡星保持较好的敏感性。结论该地区血流感染以革兰阴性杆菌为主,其中布鲁氏菌占血培养的第3位,具有明显的区域性,临床经验用药需要重视。

Objective To understand the distribution and drug resistance of pathogenic bacteria causing bloodstream infection in this region so as to provide reference for clinical rational drug use.Methods The retrospective investigation method was adopted.The main pathogenic bacteria isolated from blood culture samples from the outpatient department,emergency department and inpatients of this hospital from January to December 2016 and drug resistance were analyzed.The blood specimens were cultured by adopting the Bact/Alert3 Dautomatic blood culture system.The pathogenic bacterial identification and drug susceptibility test were performed by using the VITEK-2 Compact automatic microorganism identification system.Results A total of882 strains of pathogenic bacteria were detected,in which 607 strains（68.82%）were Gram-negative bacteria,221 strains（25.06%）were Gram positive bacteria,23 strains（2.61%）were fungi,and 31 strains（3.51%）were anaerobic bacteria.The top five pathogenic bacteria in clinical bloodstream infection were in turn Escherichia coli（32.54%）,Klebsiella pneumoniae（12.05%）,Brucella spp.（8.05%）,Staphylococcus aureus（7.48%）and Enterococcus faecium（4.99%）.The detection rate of methicillin-resistant Staphylococcus aureus（MRSA）was 13.41%;vancomycin and teicoplanin resistant Gram-positive bacteria were not detected.The resistance rates Escherichia coli,Klebsiella pneumoniae,Enterobacter cloacae and other Enterobacteriaceae to cefuroxime and ceftriaxone were high,meanwhile the resistance of Escherichia coli to impenem existed,the resistance rate was 2.40%;the resistance rates of Acinetobacter baumannei to clinically commonly used antibacterial drugs were high,and only maintained good sensitivity to minocycline and amikacin.Conclusion The bloodstream infection in this region is mainly Gram-negative bacteria,in which Brucella occupies the third place of blood culture and has obvious regional characteristics,so the clinical empirical medication needs to pay attention.