海南某医院2019~2021年血培养分离菌的分布特征及耐药性分析

Distribution characteristics and drug resistance analysis of bacteria isolated from blood culture in a tertiary hospital in Hainan from 2019 to 2021

目的了解海南文昌某三甲医院血培养分离菌的分布特征及其耐药性,为临床合理使用抗菌药物及医院感染控制提供参考。方法收集文昌市人民医院2019年1月至2021年12月门/急诊及住院患者血培养分离菌标本,依照2018年版美国临床和实验室标准协会标准,采用SPSS统计软件对血培养分离菌的分布情况及菌株耐药试验结果进行分析。结果32995份血培养标本中共分离出病原菌2115株,阳性率6.41%,其中革兰阴性杆菌1132株(53.52%),革兰阳性菌930株(43.97%),真菌53株(2.51%)。前五位分离菌分别为大肠埃希菌(31.21%)、凝固酶阴性葡萄球菌(20.38%)、肺炎克雷伯菌(11.77%)、化脓链球菌(6.48%)和金黄色葡萄球菌(6.38%)。耐甲氧西林金黄色葡萄球菌检出率为9.30%,未发现对利奈唑胺及万古霉素耐药的金黄色葡萄球菌;大肠埃希菌和肺炎克雷伯菌对头孢曲松的耐药率分别为22.56%和12.82%,产超广谱β-内酰胺酶(extended spectrumβlactamase,ESBL)菌株的检出率分别为21.14%和12.18%,不产ESBL的大肠埃希菌对亚胺培南和厄他培南的平均耐药率分别为0.60%和0.21%;铜绿假单胞菌对亚胺培南和美罗培南的平均耐药率分别为5.26%和7.69%,鲍曼不动杆菌对亚胺培南的平均耐药率为7.41%。3年的多重耐药检出率平均值为5.58%,其中大肠埃希菌的多重耐药检出率最高,达13.18%。结论本院血培养分离菌以革兰阴性杆菌为主,少部分细菌未见耐药现象,大部分细菌对常用抗菌药物均有不同程度的耐药,且多重耐药的检出率整体呈上升趋势,应加强细菌耐药性监测及医院感染控制管理,合理使用抗菌药物。

Objective To investigate the distribution characteristics and drug resistance of bacteria isolated from blood cultures in a tertiary hospital in Wenchang,Hainan Province,and to provide reference for the rational use of antibiotics and control of nosocomial infections.Methods Blood culture isolate samples from outpatient/emergency and inpatient patients in People’s Hospital of Wenchang City from January 2019 to December 2021 were collected,and the distribution of blood culture isolates and drug resistance test results were analyzed by SPSS statistical analysis software in accordance with the 2018 American Clinical and Laboratory Standards Institute.Results A total of 2115 strains of pathogenic bacteria were isolated from 32995 blood culture samples,with a positive rate of 6.41%,including 1132 Gram negative bacillus(53.52%),930 Gram positive bacteria(43.97%),and 53 fungi(2.51%).The top five bacteria were Escherichia coli(31.21%),coagulase negative staphylococcus(20.00%),Klebsiella pneumoniae(11.77%),Streptococcus pyogenes(6.48%),and Staphylococcus aureus(6.38%).The detection rate of methicillin resistant staphylococcus aureus was 9.3%,and no Staphylococcus aureus resistant to linezolid and vancomycin were found.The resistance rates of Escherichia coli and Klebsiella pneumoniae to ceftriaxone sodium were 22.56%and 12.82%,respectively,and the detection rates of extended spectrumβlactamase(ESBL)producing were 21.14%and 12.18%,respectively;the resistance rates of Escherichia coli without ESBL to imipenem and ertapenem were 0.60%and 0.21%respectively.The average resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 5.26%and 7.69%,respectively,and the average resistance rate of Acinetobacter baumannii to imipenem was 7.41%.The average multidrug resistance detection rate from 2019 to 2021 was 5.58%,and the multidrug resistance detection rate of Escherichia coli was the highest at 13.18%.Conclusion The isolated bacteria from blood cultures in our hospital are mainly Gram negative bacillus,and a small number of bacteria do not show drug resistance.Most bacteria have varying degrees of resistance to common antibiotics,and the overall detection rate of multidrug resistance is increasing.We should strengthen the monitoring of bacterial drug resistance and the control and management of nosocomial infections,and use antibiotics reasonably.