血液感染病原菌分布及耐药性分析

Analysis of Antibiotic Resistance of Pathogenic Bacteria in Bloodstream Infections

目的分析阿克苏地区第一人民医院检验科2022年1月1日至2023年6月30日期间2454例血液感染患者的血液感染病原菌分布及其耐药性,为临床合理用药提供科学依据。方法对2454例血液感染患者的病原菌分离数据进行回顾性分析,重点考察大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌、阴沟肠杆菌、肺炎链球菌和屎肠球菌(D群)等主要病原菌的耐药性。结果在2454例血液感染患者中,大肠埃希菌占26.00%,金黄色葡萄球菌占11.70%,肺炎克雷伯菌占10.47%,人葡萄球菌占9.01%,表皮葡萄球菌占5.58%,马耳他布鲁菌占4.44%,阴沟肠杆菌占3.18%,肺炎链球菌占2.89%,屎肠球菌(D群)占2.69%,溶血葡萄球菌占2.32%,鲍曼不动杆菌占2.28%,奇异变形菌和铜绿假单胞菌各占1.10%,真菌和其他未分类的病原菌合计占比15.45%。血液感染中主要革兰阴性杆菌耐药性:大肠埃希菌对头孢曲松耐药率为43.40%,对氨苄西林耐药率为73.61%;肺炎克雷伯菌对头孢他啶耐药率为57.14%,对亚胺培南耐药率为25.88%;阴沟肠杆菌对头孢他啶耐药率为27.27%,对亚胺培南耐药率为15.62%。血液感染中主要革兰阳性杆菌耐药性:金黄色葡萄球菌对青霉素G的耐药率为89.62%,对万古霉素和利奈唑胺的耐药率均为0%;肺炎链球菌对四环素的耐药率为72.22%,对万古霉素和利奈唑胺的耐药率也为0%;屎肠球菌对青霉素G的耐药率高达97.22%,对环丙沙星和左旋氧氟沙星的耐药率分别为79.31%和79.31%,对万古霉素的耐药率为2.77%。结论血液感染中病原体的耐药性是多样化的,临床用药应根据病原体的类型及其耐药性特点进行个体化,以提高治疗效果,减少耐药性的发生。同时,加强病原菌耐药性监测,为临床用药提供科学依据,是降低血液感染患者死亡率的关键措施。

Objective To analyze the distribution and drug resistance of bloodstream infection pathogens in the laboratory of the First People’s Hospital of Aksu region from January 1,2022 to June 30,2023,and to provide scientific reference for clinical rational drug use.Methods The data of pathogens isolated from 2454 patients with bloodstream infection were analyzed retrospectively,focusing on the drug resistance of Escherichia coli,Staphylococcus aureus,Klebsiella pneumoniae,Enterobacter cloacae,Streptococcus pneumoniae,Enterococcus faecium(Group D),and other major pathogens.Results Among 2454 patients with bloodstream infection,Escherichia coli accounted for 26.00%,Staphylococcus aureus accounted for 11.70%,Klebsiella pneumoniae accounted for 10.47%,Staphylococcus hominis accounted for 9.01%,Staphylococcus epidermidis accounted for 5.58%,Brucella melitensis accounted for 4.44%,Enterobacter cloacae accounted for 3.18%,Streptococcus pneumoniae accounted for 2.89%,and fungi and other unclassified pathogens accounted for 15.45%.Drug resistance of gram-positive bacilli in bloodstream infection:the drug resistance rate of Escherichia coli to ceftriaxone was 43.40%,and the drug resistance rate to ampicillin was 73.61%;The resistance rates of Klebsiella pneumoniae to ceftazidime and imipenem were 57.14%and 25.88%,respectively.The resistance rates of Enterobacter cloacae to ceftazidime and imipenem were 27.27%and 15.62%,respectively.Drug resistance of gram-negative bacilli in bloodstream infection:the drug resistance rate of Staphylococcus aureus to penicillin G was 89.62%,and the drug resistance rates to vancomycin and linezolid were 0%;The resistance rate of Streptococcus pneumoniae to tetracycline was 72.22%,and the resistance rate to vancomycin and linezolid was also 0%.The resistance rate of Enterococcus faecium to penicillin G was as high as 97.22%,to ciprofloxacin and levofloxacin were 79.31%and 79.31%respectively,and to vancomycin was 2.77%.Conclusion The drug resistance of pathogens in bloodstream infection is diversified,and the clinical medication should be individualized according to the types of pathogens and their drug resistance characteristics,so as to improve the therapeutic effect and reduce the occurrence of drug resistance.At the same time,strengthening the monitoring of drug resistance of pathogenic bacteria and providing scientific basis for clinical med-ication are the key measures to reduce the mortality of patients with bloodstream infection.