临床血培养病原菌分布及耐药性分析

Analyses of distribution and drug resistance of clinical blood culture of pathogens

目的分析本院血培养主要病原菌的分布及耐药情况。方法对丽江市人民医院2015年1月-2018年12月送检血培养标本的致病菌培养分离结果和药物敏感性(药敏)结果进行回顾性统计分析。结果 2015年1月-2018年12月本院共送检血培养标本14 328份,分离病原菌408株,分离率为2.85%。408株病原菌中,革兰阴性(G^-)菌258株(占63.2%),革兰阳性(G^+)菌150株(占36.8%)。G^-菌中分离率前2位是大肠埃希菌216株(52.9%)、肺炎克雷伯菌32株(7.8%);G^+菌中分离率前3位是凝固酶阴性葡萄球菌(52株,12.7%)、草绿色链球菌(36株,8.8%)、屎肠球菌(28株,6.9%)。药敏实验结果显示,在大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶(ESBLs)检出率分别为34.3%和12.5%;大肠埃希菌和肺炎克雷伯菌对氨苄西林和哌拉西林的耐药率均超过50%,而对阿米卡星和碳青霉烯类抗菌药物均敏感;G^+菌对红霉素、克林霉素、四环素的耐药率均超过50%;草绿色链球菌对青霉素和万古霉素完全敏感;而凝固酶阴性葡萄球菌和屎肠球菌对青霉素耐药率均超过60%,对喹奴普汀/达福普汀、利奈唑胺、替加环素、万古霉素则完全敏感。结论本院血培养病原菌检出率低,G^-菌分离率高于G^+菌,病原菌构成多变,普遍存在耐药情况。

Objective To analyze the distribution and drug resistance of the main pathogens in blood culture in our hospital. Methods The results of pathogen culture and isolation and drug susceptibility of blood culture specimens from January 2015 to December 2018 in Lijiang Municipal People’s Hospital were retrospectively and statistically analyzed. Results From January 2015 to December 2018, a total of 14 328 blood test specimens were collected and 408 strains of pathogens were isolated, and the isolation rate was 2.85%. Of the 408 strains of pathogens, 258(63.2%) were Gram-negative(G^-) bacteria and 150(36.8%) were Gram-positive(G^+) bacteria.The isolates in the G^-bacteria with top two percentages of isolation were Escherichia coli 216 strains(52.9%)and Klebsiella pneumoniae 32(7.8%);the isolates in the G^+ bacteria with top three percentages of isolation were coagulase-negative Staphylococci 52(12.7%), Streptococcus viridans 36(8.8%), and Enterococcus faecium 28(6.9%). The results of drug susceptibility test showed that the detection rates of Escherichia coli and Klebsiella pneumoniae producing hyperspectral β-lactamase(ESBLs) were 34.3% and 12.5%, respectively. The resistance rates of Escherichia coli and Klebsiella pneumoniae to ampicillin and piperacillin were all more than 50%, but sensitive to amikacin and carbapenem. Among the G^+ bacteria, the resistance rates to erythromycin, clindamycin and tetracycline were all more than 50%;streptococci viridian were completely sensitive to penicillin and vancomycin,while coagulase-negative Staphylococci and Enterococci were resistant to penicillin, the drug resistance rate being more than 60%, but they were completely sensitive to quinopentine/dafoptin, linezolid, tigecycline and vancomycin. Conclusions The detection rate of pathogens in blood culture in our hospital is low. The isolation rate of G^-bacteria is higher than that of G^+ bacteria, the composition of pathogens is varied, and the existence of drug resistance is quite general.