合肥地区血培养阳性病原菌的分布和耐药性分析

Distribution and drug-resistance of pathogens isolated from blood cultures in Hefei

目的分析血培养阳性菌的分布和耐药性,为指导临床合理用药提供实验依据。方法使用西门子MicroScanWalkAway 96PLUS全自动微生物鉴定及药敏分析仪对血培养阳性菌株进行鉴定和药敏实验,药敏结果判断参考CLSI 2014年标准,应用WHONET 5.6软件进行耐药性统计分析。结果共分离血培养阳性菌株307例,革兰阴性杆菌193株(62.87%),革兰阳性球菌96株(31.27%),真菌18株(5.86%)。革兰阴性分离菌以大肠埃希氏菌为主,其产ESBLs率为54.64%,其次为肺炎克雷伯氏菌,产ESBLs率为11.54%。革兰阳性球菌以人葡萄球菌、表皮葡萄球菌、金黄色葡萄球菌为主,耐甲氧西林金黄色葡萄球菌(MRSA)检出率为58.33%,未检出对万古霉素、利奈唑胺耐药的葡萄球菌。大肠埃希菌对β内酰胺类抗生素耐药率较高,对碳青霉烯类抗生素耐药率较低。肺炎克雷伯菌对β内酰胺类抗生素耐药率较高,对喹诺酮类、碳青霉烯类抗生素耐药率较低。未检出对万古霉素和利奈唑胺耐药的葡萄球菌,真菌对两性霉素B和5-氟胞嘧啶均为敏感。结论血培养阳性菌以肠杆菌科、葡萄球菌为主,不同病原菌的耐药性不同,应加强细菌耐药性检测,为临床合理用药提供实验依据。

Objective The distribution and drug-resistance status of pathogens in positive blood cultures were analyzed to guide reasonable applied drugs in clinic.Methods The identification and drug-sensitivity of pathogens in positive blood culture were tested by Siemens MicroScanWalkAway 96PLUS.The result of drug sensitivity was defined according to the criteria of CLSI 2014,and the drug-resistance was statistically analyzed by WHONET 5.6.Results A total of 307 strains of pathogens in positive blood cultures were isolated,including 193 strains of gram-negative(62.87%)bacteria,96 strains of Gram positive bacteria(31.27%)and 18 strains of fungi(5.86%).The gram-negative bacteria were mainly Escherichia coli(E.coli),followed by Klebsiella pneumoniae(K.pneumoniae),the detection rates of extended-spectrumβ-lactamases in E.coli and K.pneumoniae were 54.64%and 11.54%.The staphylococcus resistant to vancomycin or linezolid was not found.The resistance rate of Escherichia coli toβ-lactam antibiotics was higher than that to carbapenem antibiotics.Klebsiella pneumoniae has a high resistance rate toβ-lactam antibiotics,but a low resistance rate to quinolones and carbapenems.The fungi was sensitive to both amphotericin B and 5-fluorocytosine.Conclusions Gram-negative bacteria and staphylococcus are the main strains in the positive blood cultures.Different pathogens had different drug resistance.It is essential to detect the resistant rate of bacilli,so as to provide experimental evidence for clinical reasonable use of medicine.