某三甲医院2017-2021年血流感染病原菌分布及耐药分析

Distribution and Antibiotic Resistance Analysis of Pathogenic Bacteria of Bloodstream Infections in A Tertiary Hospital from 2017 to 2021

目的探讨清远市人民医院2017—2021年血流感染的病原菌分布及耐药率,为临床合理选择抗菌药物、控制血流感染提供参考依据。方法采用VITEK2、BD Phoenix M50全自动细菌鉴定药敏分析系统进行细菌鉴定及药敏试验,药敏结果使用2020年CLSI标准进行判读,并应用WHONET 5.6软件分析数据。结果共分离出血培养阳性菌株3263株,其中细菌3238株(占99.23%),真菌25株(占0.77%)。耐甲氧西林金黄色葡萄球菌(MRSA)、耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为26.00%、67.20%,未检出对万古霉素、利奈唑胺耐药的葡萄球菌。粪肠球菌对常用抗菌药物的敏感性均高于屎肠球菌,同时发现耐万古霉素屎肠球菌一株。主要肠杆菌科细菌对美罗培南、亚胺培南的耐药率均低于10.00%。非发酵革兰氏阴性杆菌中铜绿假单胞菌对两种碳青霉烯类抗菌药物的耐药率均低于10.00%,鲍曼不动杆菌均高于40.00%。结论多重耐药菌株的高检出率,对临床控制血流感染造成极其严峻的挑战。因此,需严格掌握抗菌药物的适应证,指导临床合理选择抗菌药物。

Objective To explore distribution and drug resistance rate of pathogenic bacteria of bloodstream infections at Qingyuan People's Hospital from 2017 to 2021,and provide reference for rational selection of antibiotics and control of bloodstream infections in clinical practice.Methods The paper carried out bacterial identification and drug sensitivity testing with VITEK2 and BD Phoenix M50 fully automatic bacterial identification and drug sensitivity a nalysis system,interpreted drug sensitivity results with 2020 CLSI standard,and analyzed data with WHONET 5.6 software.Results 3263 positive strains of bleeding culture were isolated,including 3238 bacterial strains(99.23%)and 25 fungal strains(0.77%).Detection rates of methicillin-resistant Staphylococcu s aureus(MRSA)and methicillin-resistant coagulase negative Staphylococcus(MRCNS)were 26.0%and 67.2%respectively.No Staphylococcus aureus resistant to vancomycin or linezolid was detected.Sensitivity of Enterococcus faecalis to commonly used antibiotics was higher than Enterococcus faecalis,and a strain of Enterococcus faecalis resistant to vancomycin was found.Resistance rates of major Enterobacteriaceae bacteria to meropenem and imipenem were both below 10%.Resistance rates of Pseudomonas aeruginosa to two carbapenems in non fermenting Gram negative bacteria were both below 10%,while Acinetobacter baumannii was above 40%.Conclusion High detection rate of multidrug-resistant bacterial strains poses extremely serious challenges to clinical control of bloodstream infections.Therefore,it is necessary to grasp indications of antibiotics and guide clinical rational selectio n of antibiotics strictly.