1113株血流感染分离病原菌状况及耐药性特征

Distribution and drug resistance analysis of 1 113strains of bloodstream infection

目的分析某三甲医院住院患者血流感染病原菌分布及药敏特点,为临床诊断治疗血流感染提供依据。方法收集2015年6月至2018年4月发生血流感染患者的菌株及临床资料,并行菌种鉴定及药敏试验;使用浓度梯度法对厌氧菌进行药敏检测。结果 1 101例血流感染患者中24例为复合菌感染,共分离出1 113株病原菌,其中革兰阴性菌576株(51.75%),革兰阳性菌占510株(45.82%),真菌27株(2.43%),其中厌氧菌72株,布鲁菌108株,少见菌非结核分枝杆菌、奴卡菌各1株。病原菌分布的前7位科室分别是血液内科、感染性疾病科、老年病科、新生儿科、小儿内科、肿瘤科和重症医学科。大肠埃希菌和肺炎克雷伯菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、阿米卡星、替加环素保持较高的抗菌活性;耐甲氧西林金黄色葡萄球菌和凝固酶阴性葡萄球菌的检出率分别为27.8%和82.2%,所有葡萄球菌对万古霉素、利奈唑胺均敏感;屎肠球菌、粪肠球菌对高浓度庆大霉素的耐药率大于50%,所有肠球菌对糖肽类、噁唑烷酮类抗生素均敏感;厌氧菌平均β-内酰胺酶产生率为44.4%,其中脆弱拟杆菌产酶率最高(87.5%)。结论临床各科室血流感染分离菌株类型特点各异;该地区应警惕布鲁菌和耐甲氧西林葡萄球菌感染;临床实验室不要忽视厌氧菌和低毒菌种,如非结核分枝杆菌和奴卡菌。

Objective To investigate the pathogenic bacteria distribution and drug sensitivity of blood stream infection in patients and provide basis for clinical treatment of blood stream infection.Methods Strains and clinical data of patients with blood stream infection from June 2015 to April 2018 were collected.Strains identification and susceptibility tests were performed using vitek-2 compact.Anaerobic bacteria were detected by concentration gradient method.Results A total of 1 113 strains of pathogens were isolated from 1 101 patients.24 patients were treated with mix bacteremia.There were 576(51.75%)strains of gram-negative bacteria,510(45.82%)strains of gram-positive bacteria,27(2.43%)strains of fungi and 72 strains of Anaerobic bacteria were isolated.The first seven departments of the distribution of pathogenic bacteria are hematology,infectious diseases,geriatrics,neonatology,pediatric medicine,oncology and critical care.The strains of Escherichia coli and Klebsiella pneumoniae have high antibacterial activity against piperacillin/tazobactam,cefoperazone/sulbactam,amikacin and tegacycline.The detection rates of MRSA and MRCNS were 27.8%and 82.2%respectively.All Staphylococci were sensitive to vancomycin and linezolid.All enterococci were sensitive to glycopeptides and oxazolidinone antibiotics.Anaerobic bacteria produce an average of 44.4%of theβ-lactamase.The rate of fragile bacteroides is Highest(87.5%).Conclusion The characteristics of strains from bloodstream were different.The area should be alert to brucella and methicillin resistant Staphylococcus infection;Clinical laboratories should not overlook anaerobic and low-toxic species such as nontuberculosis mycobacteria and nocardia in bloodstream.