2018—2020年某医院血培养病原菌分布及耐药性分析

Distribution and Drug Resistance Analysis of Pathogenic Bacteria in Blood Culture of a Hospital from 2018 to 2020

目的 了解2018—2020年南阳市第二人民医院血培养分离病原菌的分布及药物敏感性的变化,为临床抗感染治疗提供依据。方法 回顾性分析2018—2020年南阳市第二人民医院所有血培养阳性患者的病原菌分布及药敏结果,采用WHONET5.6及SPSS 25.0软件对结果进行统计分析。结果共送检血培养9543份,分离出病原菌937株,阳性检出率为9.8%。其中革兰阳性菌446株(47.6%),革兰阴性菌477株(50.9%),真菌14株(1.5%)。革兰阳性菌主要检出细菌为表皮葡萄球菌,金黄色葡萄球菌,人葡萄球菌;革兰阴性菌主要检出细菌为大肠埃希菌,肺炎克雷伯菌。2018—2020年,除凝固酶阴性葡萄球菌对克林霉素的耐药率下降外(P<0.05),金黄色葡萄球菌和凝固酶阴性葡萄球菌对抗菌药物的耐药率差异无统计学意义(P>0.05)。耐甲氧西林金黄色葡萄球菌(MRSA)占53.2%。未检出对万古霉素、利奈唑胺、替考拉宁耐药的葡萄球菌。大肠埃希菌对除阿米卡星外的其他抗菌药物的耐药率差异均无统计学意义(P>0.05),肺炎克雷伯菌对除复方磺胺甲恶唑的耐药率均明显下降(P<0.05)。对碳青霉烯类耐药的肺炎克雷伯菌(CRKP)检出率为17.2%,未检出对碳青霉烯类耐药的大肠埃希菌。结论 2018—2020年,我院血培养检出的葡萄球菌和大肠埃希菌的耐药率差异不大,肺炎克雷伯菌的耐药率明显下降。MRSA和CRKP的检出率高于全国平均水平,应加强细菌耐药监测,遏制细菌耐药的增加,指导临床合理用药。

Objective To understand the distribution and changes of drug sensitivity of pathogenic bacteria isolated from blood culture in Nanyang Second People’s Hospital from 2018 to 2020,and to provide evidence for clinical anti-infection treatment.Methods The distribution of pathogenic bacteria and drug sensitivity results of all patients with positive blood culture in nanyang second people’s hospital from 2018 to 2020 were retrospectively analyzed,and statistical analysis was conducted by using WHONET5.6 and SPSS 25.0 software.Results A total of 9543 blood cultures were sent for examination,and 937 strains of pathogenic bacteria were isolated,with a positive detection rate of 9.8%.There were 446 strains (47.6%) of gram-positive bacteria,477 strains (50.9%) of gram-negative bacteria and 14 strains (1.5%) of fungi.Gram-positive bacteria were mainly S.epidermidis,S.aureus and S.hominis.Gram-negative bacteria were mainly E.coli and K.pneumoniae.From 2018 to 2020,the resistance rate of coagulase-negative Staphylococcus to clindamycin decreased (P<0.05).S.aureus and coagulase negative Staphylococcus had no significant difference in antibiotic resistance rate (P>0.05).Methicillin-resistant S.aureus (MRSA) accounted for 53.2%.No Staphylococci resistant to vancomycin,linezolid and teicoranin were detected.There was no significant difference in resistance rate of E.coli to other antibiotics except amikacin (P>0.05),the drug resistance rates of K.pneumoniae to cotrimoxazole were significantly decreased (P<0.05).The detection rate of carbapenem-resistant K.pneumoniae (CRKP) was 17.2%,and no carbapenem-resistant E.coli was detected.Conclusion From 2018 to 2020,there was no significant difference in drug resistance rate between Staphylococcus and E.coli detected in blood culture of our hospital,and the drug resistance rate of K.pneumoniae decreased significantly.The detection rates of MRSA and CRKP were higher than the national average,so bacterial resistance monitoring should be strengthened to curb the increase of bacterial resistance and guide clinical rational drug use.