2015～2017年陕西省人民医院临床血流感染病原菌的分布及耐药性分析

Distribution and Drug Resistance of Pathogenic Bacteria of Blood Culture in Shaanxi Provincial People’s Hospital form 2015 to 2017

目的分析陕西省人民医院2015~2017年血培养病原菌的分布及耐药性变迁,为临床诊断和治疗提供数据依据。方法收集2015~2017年住院患者血培养阳性标本2 599份,依据美国临床实验室标准化协会(CLSI) 2016年标准,采用WHONET 5.6和SPSS17.0软件进行数据分析。结果 2 599株病原菌中革兰阳性菌1 141株(43.9%);革兰阴性菌1 282株(49.3%)和真菌176株(6.8%)。临床科室以重症医学科(425株,16.4%)、新生儿科(188株,7.2%)、急诊外科(216株,8.3%)、呼吸内科(199株,7.7%)和肝胆外科(185株,7.1%)等为主。血培养阳性菌存在季节分布,夏季高于其他季节。革兰阳性菌以表皮葡萄球菌(260株,10%)和金黄色葡萄球菌(177株,6.8%)为主,其对克林霉素、红霉素、苯唑西林的耐药率均>50%。革兰阴性菌中以大肠埃希菌(572株,22%)和肺炎克雷伯菌(238株,9.2%)最为常见,对头孢呋辛、哌拉西林及复方新诺明耐药率>52%;对碳青霉烯类抗生素耐药率<2.4%。结论血培养分离出的病原菌以革兰阴性为主,临床应加强血流感染的耐药监测,合理用药。

Objective To explore the distribution and drug resistance of 2 599 strains of pathogenic bacteria cultured in shaanxi Provence People’s Hospital from 2015 to 2017 so as to provide guidance for the clinical diagnosis and treatment.Methods 2 599 specimens of blood culture were collected from 2015 to 2017,according to 2016 standards of American Clinical and Laboratory Standards Institute(CLSI),data were analyzed with WHONET 5.6 and SPSS17.0 software.Results Total of 2 599 strains of pathogens were isolated.About pathogens 1 141 specimens were gram-positive bacteria strains accounting for 43.9%,1 282 specimens were gram-negative bacteria strains,accounting for 49.3%.176 strains of fungi accounting for 6.8%.Positive pathogens were mainly distributed in ICU(n=425,16.4%),neonatology department(n=188,7.2%),emergency surgery(n=216,8.3%),respiratory medicine(n=199,7.7%) and hepatobiliary surgery(n=185,7.1%).There was seasonal distribution of the positive bacteria rate in blood culture,which was higher in summer than in other seasons.Gram-positive bacteria were mainly on Staphylococcus epidermidis(n=260,10%) and Staphylococcus aureus(n=177,6.8%),the drug resistance of them to clindamycin,erythromycin and oxacillin were all>50%.The great majority of gram-negative bacteria was Escherichia coli(n=572,22%) and Klebsiella pneumonia(n=238,9.2%),the resistance rates of them to cephalosporins,piperacillin and sulfamethoxazole were >52%,and the resistance rate of E.coli to carbapenems was less than 2.5%.Conclusion The Gram-negative bacilli took the major part of the positive blood culture of the hospital.Escherichia coli were the main pathogenic bacteria.The clinical should strengthen the drug resistance monitoring of the pathogenic bacteria from blood and rationally use drugs.