血培养病原菌报阳时间、菌群分布及耐药性分析

Time to Positivity,Distribution and Drug Resistance of Pathogenic Bacteria in Blood Culture

目的分析东莞大朗医院的血培养病原菌的报阳时间、分布特点和药敏情况,为血流感染的防控与临床合理使用抗生素提供依据。方法对东莞大朗医院2018年6月到2020年6月血培养病原菌的报阳时间、分布特点和药敏情况进行回顾分析。结果 4 560份血培养标本中共分离373株病原菌,阳性率为8.5%(373/4 560)。373株阳性病原菌构成比前5位分别是:大肠埃希菌95株(25.5%)、凝固酶阴性葡萄球菌73株(19.6%)、肺炎克雷伯菌47株(12.6%)、铜绿假单胞菌26株(7.0%)、金黄色葡萄球菌22株(5.9%)。血培养病原菌平均报阳时间最早是大肠埃希菌(12.5 h),其次是肺炎克雷伯菌(15.3 h)、金黄色葡萄球菌(17.4 h),最晚是真菌(56.5 h)。CNS对青霉素G、复方新诺明、红霉素、环丙沙星、左氧沙星耐药率>40%,未发现对万古霉素、利奈唑胺、替加环素耐药的葡萄球菌。大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶(ESBLs)分别为45.6%与27.0%,亚胺培南、厄他培南、哌拉西林/他唑巴坦、头孢替坦对大肠埃希菌、肺炎克雷伯菌耐药率<3%,有很好的抗菌活性。结论东莞大朗医院血培养病原菌以大肠埃希菌为主,临床医生应根据病原菌的报阳时间及药敏结果选择合适的抗菌药物,同时继续加强耐药监测。

Objective To analyze the time to positivity,distribution and drug resistance of pathogenic bacteria in blood culture in Dalang Hospital of Dongguan to provide a basis for the prevention and control of bloodstream infections and the adequate use of antibiotics in clinical practice.Methods A retrospective analysis of the time to positivity,distribution features and drug susceptibility of pathogenic bacteria in blood culture in Dalang Hospital of Dongguan from June 2018 to June 2020.Results Three-hundred and seventy three strains of pathogens were isolated from 4 560 blood culture specimens in the hospital,and the positive rate was 8.5%(373/4 560).The top 5 pathogens among 373 strains of blood culture positive bacteria was as follows:95 strains of Escherichia coli(25.5%),73 strains of coagulase-negative Staphylococcus(19.6%),47 strains of Klebsiella pneumoniae(12.60%),26 strains(7.0%) of Pseudomonas and 22 strains(5.9%) of Staphylococcus aureus.The average time to positive pathogenic bacteria in blood culture was 12.5 hours for Escherichia coli,15.3 hours for Klebsiella pneumoniae,17.4 hours for Staphylococcus aureus and 56.5 hours for fungus.The resistance rate of Staphylococcus to penicillin G,compound trimethoprim,erythromycin,ciprofloxacin,and levofloxacin exceeds 40% and no strains resistant to vancomycin,linezolid and tigecycline were found.Escherichia coli and Klebsiella pneumoniae produced 45.6% and 27.0% of extended-spectrum β-lactamases(ESBLs) respectively.Imipenem,ertapenem,piperacillin/tazobactam,and cefotetan have a resistance rate of less than 3% to Escherichia coli and Klebsiella pneumoniae,which shows good antibacterial activity.Conclusion The blood culture pathogens in Dalang Hospital of Dongguan are predominated by Escherichia coli.Clinicians select appropriate antibacterial drugs based on the time to positivity and susceptibility of pathogens,and continue to strengthen drug resistance monitoring.