2017—2020年血培养阳性病原菌分布及耐药性分析

Analysis on the Distribution and Drug Resistance of Blood Culture Positive Pathogen in the Third Affiliated Hospital of Jinzhou Medical University from 2017 to 2020

目的分析血培养阳性病原菌分布及耐药性特点,为临床治疗方案提供依据。方法收集锦州医科大学附属第三医院2017—2020年575份血培养阳性病原菌,所有血液标本按常规方法进行细菌分离、培养、鉴定,按统一方案K-B琼脂扩散法进行抗菌药物敏感试验。结果血培养标本中共获分离细菌575株,重症监护室是血培养阳性菌分布最主要的病区。最常见的分离菌分别为大肠埃希菌(28.35%)、凝固酶阴性葡萄球菌(CNS)(24.17%)、肺炎克雷伯菌(13.57%)、金黄色葡萄球菌(5.74%)、鲍曼不动杆菌(4.52%)、铜绿假单胞菌(3.65%)、嗜麦芽窄食单胞菌(0.87%),奇异变形杆菌(0.70%),共占分离菌株的81.57%。MRSA及MRCNS分别占金葡菌和CNS的27.27%和77.70%;葡萄球菌对万古霉素和利奈唑胺的敏感率为100%。大肠埃希菌、肺炎克雷伯菌中产ESBLs菌株的检出率分别为46.63%和20.51%;大肠埃希菌对碳青霉烯类仍高度敏感(耐药率为0.61%~1.84%),但肺炎克雷伯菌对碳青霉烯类耐药率较高(耐药率为15.38%~16.67%);阿米卡星和头孢哌酮-舒巴坦对肠杆菌科细菌具有高度抗菌活性(耐药率为0%~6.41%)。鲍曼不动杆菌对大部分受试药物耐药严重,对头孢哌酮-舒巴坦和阿米卡星耐药率分别23.08%和30.77%,对其他受试药物的耐药率多为60%以上。铜绿假单胞菌对所测抗菌药物的耐药率相对较低,多在30%以下。结论(1)我院2017—2020年血培养病原菌位居前五位的的菌株分别为大肠埃希菌(28.35%)、CNS(24.17%)、肺炎克雷伯菌(13.57%)、金葡菌(5.74%)、鲍曼不动杆菌(4.52%);(2)革兰阴性菌中以大肠埃希菌和肺炎克雷伯菌最多,分离的产ESBLs菌株对碳青酶烯类、阿米卡星的耐药率较低(1.32%~18.75%),临床上可用于治疗产ESBLs细菌的首选经验性药物;(3)非发酵菌中鲍曼不动杆菌对大部分抗菌药物耐药严重,但对头孢哌酮-舒巴坦和阿米卡星耐药率分别23.08%和30.77%,具有良好抗菌活性。

Objective To investigate the distribution and drug resistance characteristics of blood culture positive pathogen in order to provide the basis for guiding clinical treatment plan.Methods A total of 575 blood culture positive pathogens were collected from the Third Affiliated Hospital of Jinzhou Medical University from 2017 to 2020.All blood samples were isolated,cultured and identified according to conventional methods,and antimicrobial susceptibility test was conducted according to the unified scheme K-B AGAR diffusion method.Results A total of 575 strains of bacteria were isolated from cultured specimens.Intensive care unit(ICU)was the main ward for the distribution of positive bacteria in blood culture.The most common isolates were escherichia coli(28.35%),coagulase negative staphylococcus(CNS)(24.17%),klebsiella pneumoniae(13.57%),staphylococcus aureus(5.74%),acinetobacter baumannii(4.52%),pseudomonas aeruginosa(3.65%),stenotrophomonas maltophilia(0.87%),and proteus mirabilis(0.70%),accounting for 81.57%of the isolated strains.MRSA and MRCNS accounted for 27.27%and 77.70%of S.aureus and CNS,respectively;the sensitivity rate of staphylococcus to vancomycin and linezolid was 100%.The detection rates of ESBLs in escherichia coli and klebsiella pneumoniae were 46.63%and 20.51%,respectively;Escherichia coli was still highly sensitive to carbapenems(resistance rate was 0.61%~1.84%),but klebsiella pneumoniae had a high resistance rate to carbapenems(resistance rate was 15.38%~16.67%);Amikacin and cefoperazone sulbactam showed high antibacterial activity against enterobacteriaceae bacteria(resistance rates ranged from 0%to 6.41%).Acinetobacter baumannii was severely resistant to most of the tested drugs,and the resistance rates to cefoperazone sulbactam and amikacin were 23.08%and 30.77%,respectively.The resistance rates to other tested drugs were more than 60%.The resistance rate of pseudomonas aeruginosa to the tested antibacterial drugs was relatively low,mostly below 30%.Conclusions(1)The top five strains of pathogenic bacteria in blood culture of our hospital from 2017 to 2020 were escherichia coli(28.35%),CNS(24.17%),klebsiella pneumoniae(13.57%),staphylococcus aureus(5.74%)and acinetobacter baumannii(4.52%),respectively;(2)Escherichia coli and klebsiella pneumoniae were the most common gram-negative bacteria.The isolated ESBLS-producing strains showed low drug resistance rates to carbapenes and amicacin(1.32%~18.75%),which could be used as the preferred empirical drugs for the treatment of ESBLS-producing bacteria;(3)Among the non-fermented bacteria,acinetobacter baumannii was seriously resistant to most antibacterial drugs,but the resistance rates to cefoperazone-sulbactam and amikacin were 23.08%and 30.77%,respectively,showing good antibacterial activity.