1061株血标本分离菌的分布及耐药性

Distribution and antimicrobial resistance of 1 061 pathogenic strains isolated from blood specimens

目的了解某院血标本分离菌的分布及耐药状况,为临床诊治血流感染提供实验室依据。方法对该院2015年1月1日—2016年12月31日细菌室血标本分离菌进行鉴定和药敏分析。结果共分离1 061株病原菌,其中革兰阴性菌566株(53.35%),以大肠埃希菌和肺炎克雷伯菌为主;革兰阳性菌383株(36.10%),主要以凝固酶阴性葡萄球菌(CNS)为主;真菌112株(10.55%),以近平滑假丝酵母菌为主。重症监护病房(ICU)是血标本分离菌的主要来源科室,共308株(29.03%),其次为血液内科和小儿内科。大肠埃希菌对亚胺培南耐药率为2.65%,肺炎克雷伯菌对亚胺培南的耐药率为40.12%,产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌分别占62.96%、33.14%。未发现对利奈唑胺和万古霉素耐药的葡萄球菌,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)、耐甲氧西林金黄色葡萄球菌(MRSA)的检出率分别为83.61%、45.45%。发现对万古霉素和利奈唑胺耐药的屎肠球菌各1株。结论血标本分离病原菌种类多,临床应监测病原菌分布和耐药情况,有效指导临床经验性抗感染治疗。

Objective To investigate the distribution and antimicrobial resistance of pathogens isolated from blood specimen,and provide laboratory basis for clinical treatment of bloodstream infection.Methods Pathogens isolated from blood specimen in a hospital laboratory from January 1,2015 to December 31,2016 were identified and performed antimicrobial susceptibility testing.Results A total of 1 061 pathogenic strains were isolated from blood specimen,of which gram-negative bacillus,gram-positive coccus,and fungus accounted for 53.35%(n=566),36.10%(n=383),and 10.55%(n=112)respectively,the major gram-negative bacillus,gram-positive coccus,and fungus were Escherichia coli(E.coli)and Klebsiella pneumoniae(K.pneumoniae),coagulase-negative Staphylococcus,and Candida parapsilosis respectively.Strains were mainly isolated from intensive care unit(ICU,n=308,29.03%),followed by hematology department and pediatric internal medicine department.Resistance rates of E.coli and K.pneumoniae to imipenem were 2.65%and 40.12%respectively.Extended-spectrum beta-lactamase(ESBL)-producing E.coli and K.pneumoniae accounted for 62.96%and 33.14%respectively.Linezolid-and vancomycmin-resistant Staphylococcus spp.were not found,isolation rates of methicillin-resistant coagulase-negative Staphylococcus and methicillin-resistant Staphylococcus aureus were 83.61%and 45.45%respectively,one vancomycin-resis-tant Enterococcus faecium and one linezolid-resistant Enterococcus faecium were isolated respectively.Conclusion There are multiple species of pathogens isolated from blood specimen,distribution and antimicrobial resistance of pathogens casing bloodstream infection should be monitored regularly to guide the empiric antimicrobial therapy.