2012~2022年血培养阳性病原菌分布及耐药性分析

The Analysis of Distribution and Antimicrobial Resistance of PathogenicBacteria Detected in Blood Culture from 2012 to 2022

目的 探讨北京市昌平区医院连续11年血培养阳性病原菌分布及其耐药性,为临床诊疗和抗菌药物合理使用提供依据。方法 回顾性分析2012年1月至2022年12月门诊和住院患者血培养检出的致病菌及其科室分布和耐药特点,采用全自动微生物鉴定药敏分析系统Vitek2 Compact,对病原菌进行鉴定及药敏试验,应用WHONET 5.6软件进行统计分析。结果 11年来共检测到2 056株病原菌,其中59.48%为革兰阳性菌,39.21%为革兰阴性菌,1.31%为真菌。革兰氏阳性菌主要为凝固酶阴性葡萄球菌、金黄色葡萄球菌和肠球菌,革兰氏阴性菌主要为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌。病原菌最多的5个科室分别是重症监护病区、呼吸病区、内科重症监护病区、泌外病区、心内科病区。产超广谱β-内酰胺酶的大肠埃希菌和肺炎克雷伯菌的检出率分别为57.3%和22.4%;碳青霉烯类耐药鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌和大肠埃希菌的检出率分别为68.4%、58.8%、15.0%、1.3%。耐甲氧西林金黄色葡萄球菌平均检出率为57.4%。结论 血培养检出的病原菌主要为革兰阳性菌,其中最常见的病原菌是大肠埃希菌、凝固酶阴性葡萄球菌和肺炎克雷伯菌。加强血培养采集规范培训和定期进行病原菌监测有利于抗菌药物的临床合理应用。

Objective To understand the distribution and drug resistance of pathogenic bacteria detected in blood culture over 11 years in Changping Hospital,and to provide the knowledge base for clinical diagnosis,treatment,and rational use of antibiotics.Methods A retrospective analysis was conducted to investigate the distribution and drug resistance characteristics of pathogenic bacteria in blood cultures from January 2012 to December 2022 among outpatients and inpatients in different departments.Identification and antibiotic susceptibility testing of pathogenic bacteria were performed using the fully automated microbiological identification and antimicrobial susceptibility analysis system Vitek2 Compact.Statistical analysis was conducted using WHONET 5.6 software.Results A total of 2056 strains of pathogenic bacteria were detected during the 11-year period.Coagulase-negative staphylococci,Staphylococcus aureus and Enterococcus were found to be the predominant Gram-positive bacteria,while Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,and Acinetobacter baumannii were the predominant Gram-negative bacteria.The top five departments for pathogenic bacteria were ICU,Respiratory Ward,ICU of Internal Medicine,Urology Department,and Cardiology Department.The detection rates of extended-spectrumβ-lactamase-producing E.coli and K.pneumoniae were 57.3%and 22.4%,respectively.The detection rates of carbapenem-resistant A.baumannii,carbapenem-resistant P.aeruginosa,carbapenem-resistant K.pneumoniae,and carbapenem-resistant E.coli were 68.4%,58.8%,15.0%,and 1.3%,respectively.The average detection of MRSA was 57.4%.Conclusion Gram-positive bacteria are the predominant pathogenic bacteria detected in blood cultures,among which the most common types are E.coli,Coagulase-negative staphylococci and K.pneumoniae.Strengthening training on standardized blood culture collection and conducting regular surveillance of pathogenic bacteria will contribute to the rational use of antibiotics in clinical practice.