5 759份血培养标本病原菌分布和耐药性分析

Analysis of pathogenic bacteria distribution and antimicrobial resistance in 5 759 blood culture specimens

目的分析5 759份血培养标本病原菌分布和耐药性,旨在为临床血流感染合理选用抗菌药物提供参考依据。方法对5 759份血培养标本进行病原菌分离,观察病原菌在不同科室的分布情况、主要分离病原菌及其构成比,并分析常见病原菌对抗菌药物的耐药性。结果 5 759份血培养标本中分离出病原菌427株,阳性率为7.4%,阳性标本占比最高的科室为新生儿科(58.5%);其中革兰氏阳性菌280株(65.6%)、革兰氏阴性菌147株(34.4%);主要病原菌依次为凝固酶阴性葡萄球菌(57.6%)、大肠埃希菌(22.2%)、肺炎克雷伯菌(7.0%)、金黄色葡萄球菌(3.7%)及肠球菌属(3.5%)。未检出对利奈唑胺、替考拉宁、万古霉素耐药的葡萄球菌属和肠球菌属;大肠埃希菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、亚胺培南及美罗培南的耐药率为0.0%,肺炎克雷伯菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、亚胺培南和美罗培南的耐药率为3.3%。结论血培养病原菌复杂,以凝固酶阴性葡萄球菌为主,不同病原菌耐药性差异大,医院应加强对碳氢霉烯类耐药肺炎克雷伯菌的监测,以减少耐药菌株的出现。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 pathogenic bacteria distribution and antimicrobial resistance in 5 759 blood culture specimens, and to provide references for rational selection of antibiotics for clinical blood flow infections. Methods Pathogenic bacteria were isolated from 5 759 blood culture samples. The distribution of pathogenic bacteria in different departments, main isolated pathogenic bacteria and the composition were observed, and the antimicrobial resistance of common pathogenic bacteria was analyzed. Results A total of 427 strains of pathogenic bacteria were isolated from 5 759 blood culture samples, the positive rate was 7.4%;the department with the highest proportion of positive specimens was neonatal department(58.5%);280 strains(65.6%) were gram-positive bacteria and 147 strains(34.4%) were gram-negative bacteria;the main pathogenic bacteria were coagulase negative Staphylococcus(57.6%), Escherichia coli(22.2%), Klebsiella pneumoniae(7.0%), Staphylococcus aureus(3.7%) and Enterococcus(3.5%). Staphylococcus and Enterococcus resistant to linezolid, teicoplanin and vancomycin were not detected;the resistance rates of Escherichia coli to piperacillin/tazobactam,cefoperazone/sulbactam, imipenem and meropenem were 0.0%, and the resistance rates of Klebsiella pneumoniae to piperacillin/tazobactam, cefoperazone/sulbactam, imipenem and meropenem were 3.3%. Conclusion The pathogenic bacteria in blood culture are complex, and coagulase negative Staphylococcus is the main pathogen. The drug resistance of different pathogenic bacteria varies greatly. The surveillance of hydrocarbon-resistant Klebsiella pneumoniae should be strengthened in order to reduce the emergence of drug-resistant strains. Clinicians should attach great importance to early blood culture,rational use of antibiotics, and effectively reduce the production of drug-resistant strains.