豫西南地区某医院468株血培养病原菌分布及耐药特点分析

Distribution Characteristics and Drug Resistance of 468 Blood Isolates in a Hospital in Southwest Henan

目的分析豫西南地区某医院患者血培养病原菌的临床分布及耐药特点,为临床血流感染的诊断和治疗提供理论依据。方法回顾性分析南阳市中心医院2018年1月—2018年12月临床送检血培养阳性的468株病原菌及其抗菌药物敏感性。结果468株血培养病原菌中,革兰阳性菌共243株,占51.92%,分离率排名前三位的依次是凝固酶阴性葡萄球菌174株(37.18%)、金黄色葡萄球菌(6.20%)和屎肠球菌(3.85%),主要分布在儿科和新生儿病区;革兰阴性菌共220株,占47.00%,分离率排名前三位的依次是大肠埃希菌106株(22.65%)、肺炎克雷伯菌(12.18%)和鲍曼不动杆菌(3.42%),主要分布在普外科和重症医学病区;真菌5株,占1.07%。血培养阳性率排名前3位的科室依次是内分泌科,普外科和新生儿重症。主要病原菌的耐药情况较严重,耐甲氧西林凝固酶阴性葡萄球菌(Methicillin Resistant Coagulase-Negative Staphylococci,MRCNS)和耐甲氧西林金黄色葡萄球菌(Methicillin Resistant Staphylococcus aureus,MRSA)的发生率分别为52.30%和51.70%,未发现万古霉素和利奈唑胺耐药株;大肠埃希菌ESBLs的发生率达50.90%,肺炎克雷伯菌对亚胺培南和美罗培南的耐药率分别为26.30%和28.10%,鲍曼不动杆菌对亚胺培南和美罗培南的耐药率均为62.50%。结论南阳市中心医院血培养分离菌以葡萄球菌和肠杆菌科为主,碳青霉烯类耐药的鲍曼不动杆菌和肺炎克雷伯菌应引起高度重视,产ESBLs大肠埃希菌及MRSA仍是防治重点。

Objective To analysis the distribution characteristics and drug resistance of pathogenic isolated from patients’blood from southwest Henan and to provide a theoretical basis for the diagnosis and treatment of clinical bloodstream infection.Methods The clinical distribution and drug resistance of a total of 468 clinical isolates isolated from blood culture from January to December 2018 were retrospectively analyzed.Results In 468 isolates,243 cases were gram positive organisms and accounted for 51.92%.The top three gram positive isolates were coagulase negative staphylococcus(37.18%),staphylococcus aureus(6.20%)and enterococcus faecium(3.85%)which were mainly distributed in pediatric and neonatal wards.220 cases were gram negative organisms and accounted for 47%.The top three gram negative isolated were Escherichia coli(22.65%),Klebsiella pneumoniae(12.18%)and Acinetobacter baumannii(3.42%)which were mainly distributed in general surgery and ICU.Additionally,Five strains of fungi were isolated,accounted for 1.07%.Drug resistance of major pathogens is serious,The prevalence of methicillin-resistant strains was 80.3% in coagulase negative Staphylococcus(MRCNS)and 35.3% in S.aureus(MRSA),no staphylococcal strains were found resistant to vancomycin and linezolide.Moreover,about 26.3% and 28.1% of K.pneumoniae respectively and about 62.5% A.baumannii strains were resistant to imipenem and meropenem.Conclusion Enterobacteriaceae and staphylococcus spp.are the main pathogens causing bloodstream infection in this hospital.Carbapenem-resistant A.baumannii and K.pneumoniae should be highly valued and ESBLs-producing E.coli and MRSA are still the focus of prevention and treatment.