2268例血流感染细菌分布及耐药分析

Analysis of bacterial distribution and drug resistance in 2268 cases of bloodstream infection

目的分析2016~2018年住院患者血流感染病原菌构成及耐药特征。方法收集细菌性血流感染住院患者致病菌药敏实验结果,对致病菌的构成及药敏情况进行统计分析。结果 3年共分离阳性菌株2268例,其中革兰氏阴性菌1197株,前4位分别是大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌;革兰氏阳性菌1071例,前3位分别是凝固酶阴性葡萄球菌、屎肠球菌和金黄色葡萄球菌。金黄色葡萄菌、凝固酶阴性葡萄球菌、屎肠球菌对利奈唑胺和替加环素均100.0%敏感,对青霉素G的耐药率均在80.0%以上。2016~2018年超广谱β内酰胺酶(ESBLs)阳性大肠埃希菌检出率为64.23%,ESBLs阳性肺炎克雷伯菌检出率为31.94%;大肠埃希菌对哌拉西林/他唑巴坦、头孢替坦、亚胺培南、阿米卡星耐药率低(不足10.0%);肺炎克雷伯菌对氨苄西林/舒巴坦、头孢唑啉、头孢曲松的耐药率在50.0%以上;铜绿假单胞菌对哌拉西林/他唑巴坦、头孢他啶、头孢吡肟、阿米卡星、庆大霉素、妥布霉素、环丙沙星、左氧氟沙星的耐药率均在20.0%以下;鲍曼不动杆菌对亚胺培南、阿米卡星、左氧氟沙星的耐药率逐年升高。结论我院血流感染病原菌的耐药率与全国耐药监测网报道的平均水平相当。

Objective The pathogenic bacteria composition and drug resistance characteristics of bloodstream infection were analyzed from 2016 to 2018. Methods The pathogenic bacteria strains and drug susceptibility test results of patients with bacterial bloodstream infection were collected, and the composition and pathogenic susceptibility of the pathogenic bacteria were statistically analyzed. Results A total of 2268 positive strains were isolated in 3 years. There were 1197 strains of Gram-negative bacteria, the top four strains were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii. There were 1197 strains of Gram-positive bacteria, the top three Gram-positive bacteria were Coagulase-negative staphylococcus, Enterococcus faecium and Staphylococcus aureus. Coagulase-negative staphylococcus, Enterococcus faecium and Staphylococcus aureus were 100.0% sensitive to linezolid and tigecycline, and the resistance rates to penicillin G were all more than 80.0%. From 2016 to 2018, the detection rate of extended-spectrum β-lactamase(ESBLs)-positive Escherichia coli was 64.23%. The detection rate of Klebsiella pneumoniae was 31. 94%. The resistance rate of Escherichia coli to piperacillin/tazobactam,cefotetan,imipenem and amikacin was low(less than 10. 0%). The resistance rates of Klebsiella pneumoniae to ampicillin/sulbactam,cefazolin and ceftriaxone were more than 50. 0%. The resistance rates of Pseudomonas aeruginosa to piperacillin/tazobactam,ceftazidime,cefepime,amikacin,gentamicin,tobramycin,ciprofloxacin and levofloxacin were less than 20. 0%. The resistance rates of Acinetobacter baumannii to imipenem,amikacin and levofloxacin increased year by year. Conclusion The rate of bacterial resistance in our hospital is comparable to the average level reported by the National Drug Surveillance Network.