检验科微生物检验质量影响因素与病原菌耐药性分析

Analysis of factors affecting the quality of microbiological testing and drug resistance of pathogenic bacteria in laboratory department

目的探讨检验科微生物检验质量的影响因素及病原菌耐药性情况。方法248份微生物样本,对微生物检验质量影响因素及病原菌耐药性情况进行分析。结果248份检验报告中有32份检验结果存在误差,检验报告错误率为12.90%。调查统计32份存在误差的检验报告的采集、标本留存、送检和检验操作步骤记录,影响检验质量的因素可划分为3类:检验操作失误8例(25.00%)、标本质量问题共22例(68.75%)、工作人员失误共2例(6.25%)。细菌培养结果显示,248份微生物样本中共培养出263株病原菌,包括革兰阳性菌88株(33.46%),革兰阴性菌128株(48.67%),真菌47株(17.87%)。培养数量最多的前3类病原菌分别为金黄色葡萄球菌82株、肺炎克雷伯菌29株和大肠埃希菌61株。病原菌耐药性结果显示,金黄色葡萄球菌对青霉素、红霉素、头孢噻肟、四环素、氨苄西林的耐药性较强,肺炎克雷伯菌对阿莫西林、头孢噻肟及四环素的耐药性较强,而大肠埃希菌对头孢呋辛、头孢噻吩、四环素的耐药性较强。结论微生物检验应注意防控质量影响因素,提高检验准确度,临床治疗应根据耐药性分析选择合适药物。

Objective To discuss the the factors that affect the quality of microbiological testing and the drug resistance of pathogenic bacteria in laboratory department.Methods 248 microbial samples were collected,the factors affecting the quality of microbial testing and the drug resistance of pathogenic bacteria was analyzed.Results There were 32 test results with errors in 248 test reports,with an error rate of 12.90%.The survey counted 32 cases of test reports with errors in the collection,specimen retention,delivery and test step records,and the factors affecting the quality of test were divided into 3 categories:test errors in 8 cases(25.00%),specimen quality problems in 22 cases(68.75%),and staff errors in 2 cases(6.25%).The bacterial culture results showed that a total of 263 strains of pathogenic bacteria were cultured in 248 microbial samples,including 88 strains(33.46%)of Gram-positive,128 strains(48.67%)of Gram-negative and 47 strains(17.87%)of fungal.The top 3 types of pathogens with the highest number of cultures were 82 strains of S.aureus,29 strains of Klebsiella pneumoniae and 61 strains of Escherichia coli.The results of pathogenic bacteria resistance showed that Staphylococcus aureus was more resistant to penicillin,erythromycin,cefotaxime,tetracycline and ampicillin,Klebsiella pneumoniae was more resistant to amoxicillin,cefotaxime and tetracycline,while Escherichia coli was more resistant to cefuroxime,cefothiophene and tetracycline.Conclusion Microbiological testing should pay attention to the prevention and control of related influencing factors and improve the accuracy of the test,and clinical treatment should be based on drug resistance analysis to select appropriate drugs.