1490株血液标本分离细菌分布及其耐药性

Distribution and drug resistance of 1490 strains of bacteria isolated from blood samples

目的分析医院血培养分离菌的构成及耐药性,为临床血流感染的诊治提供参考。方法回顾性分析联勤保障部队第969医院2020年1月-2022年12月临床送检标本血培养阳性结果,参考美国临床和实验室标准化协会(CLSI)相应年份标准对药敏结果进行判读。结果共分离细菌1490株,革兰阳性菌756株(50.74%)、革兰阴性菌734株(49.26%);革兰阳性菌以凝固酶阴性葡萄球菌、屎肠球菌、金黄色葡萄球菌及粪肠球菌为主;革兰阴性菌以大肠埃希菌、马耳他布鲁菌、肺炎克雷伯菌及铜绿假单胞菌为主;儿童与成人血培养分离菌株的构成存在一定差异;耐甲氧西林金黄色葡萄球菌(MRSA)检出率低于耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)(P<0.05),葡萄球菌对替加环素、万古霉素及利奈唑胺100.00%敏感;屎肠球菌对万古霉素的耐药率为1.92%;大肠埃希菌产超广谱β-内酰胺酶(ESBLs)株检出率高于肺炎克雷伯菌产ESBLs株(P<0.05);肺炎克雷伯菌对亚胺培南、美罗培南耐药率分别为11.61%、12.50%;铜绿假单胞菌对大多数抗菌药物耐药率<15%。结论血培养分离细菌种类较多,且耐药形势严重,应加强血流感染病原学监测,为临床合理用药提供依据。

OBJECTIVE To analyze the distribution and drug resistance of pathogens isolated from blood culture in the hospital,and to provide reference for the diagnosis and treatment of clinical bloodstream infections.METHODS A retrospective analysis was conducted on the positive blood culture results of clinical samples sent to the Joint Logistic Support Force 969th Hospital from Jan 2020 to Dec 2022,and the drug sensitivity test results were interpreted according to the corresponding year standards of the American clinical laboratory standards institute(CLSI).RESULTS A total of 1490 bacterial strains were isolated from blood samples,including 756 gram-positive bacteria(50.74%)and 734 gram-negative bacteria(49.26%).The main gram-positive bacteria were coagulase negative Staphylococcus,Staphylococcus aureus,Enterococcus faecium,and Enterococcus faecalis.Escherichia coli,Klebsiella pneumoniae,Brucella Malta,and Pseudomonas aeruginosa were the most common gram-negative bacteria.There were certain differences in the composition of bacteria in blood culture between the children and the adults.The detection rate of methicillin-resistant S.aureus(MRSA)was lower than that of methicillin-resistant coagulase negative S.aureus(MRCNS)(P<0.05).Staphylococcus was 100.00%sensitive to tigecycline,vancomycin,and linezolid.The drug resistance rates of faecium was 1.92%.The detection rate of E.coli strains producing broad-spectrum bacteriaβ-lactamase(ESBLs)was significantly higher than that of K.pneumoniae strains producing ESBLs(P<0.05).The drug-resistant rates of K.pneumoniae to imipenem and meropenem were 11.61%and 12.50%,respectively,and that of P.aeruginosa to most antibiotics were all<15%.CONCLUSION There are many types of strains isolated from blood culture,which shows the severe situation of drug resistance.It is necessary to strengthen the pathogen monitoring of bloodstream infections and provide a basis for rational drug use in clinical practice.