住院患者血流感染病原菌分布与耐药变迁分析

The Changes of Bacterial Distribution and Antimicrobial Resistance in Bloodstream Infection

目的分析2012年1月至2014年12月我院住院患者血流感染病原菌的分布和耐药变化情况,为临床治疗提供依据。方法对临床分离病原菌采用VITEK-2 Compact全自动微生物分析仪进行鉴定,药物敏感试验采用K-B纸片扩散法。结果 3年共分离血流感染病原菌767株菌,革兰阴性杆菌由39.5%上升为56.1%,真菌由1.6%上升为2.2%,革兰阳性球菌由58.9%下降至41.7%。药敏结果显示大肠埃希菌对头孢类、喹诺酮类的耐药率3年间均在50%以上,肺炎克雷伯菌对喹诺酮类由2012年的全敏感上升到2014年30%左右的耐药率。鲍曼不动杆菌对大部分药物的耐药率上升到60%以上,铜绿假单胞菌耐药率3年均在30%以下。肠球菌属、葡萄球菌属等革兰氏阳性球菌对万古霉素均敏感,对青霉素耐药率较高,为45.5~100.0%。结论 2012年到2014年血流感染病原菌中革兰阳性球菌感染比例呈下降趋势,而革兰氏阴性杆菌感染呈上升趋势,常用抗生素的细菌耐药率有逐年增加趋势,加强耐药监测,合理使用抗生素,对控制细菌耐药性的发生和发展至关重要。

Objective To investigate the changes of bacterial distribution and antimicrobial resistance in bloodstream infection from 2012 to 2014 and to provide evidence for clinical treatment and control of hospital infection. Methods The bacterial isolates were identified by using VITEK- 2 Compact automatic microorganism analyzer and susceptibility testing by using disk diffusion method( K- B). Results Among 757 pathogenic strains in the three- year,Gram negative bacilli from 39. 5% to 56. 1%,fungi from 1. 6% to 2. 2%,Gram positive cocci fell to 41. 7% from 58. 9%. There was no significant change in the drug resistance rates of Escherichia coli for cephalosporins and quinolone( over 50%). The drug resistance rates of Klebsiella pneumoniae for quinolone rose to 30% from 2012 to 2014. The drug resistance rates of Acinetobacter baumannii for many drugs rose to more than 60%. There was no significant change of drug resistance rates of Pseudomonas aeruginosa in three years( below 30%). Enterococcus,Staphylococcus and other Gram positive coccus were sensitive to vancomycin,highly resistant to penicillin( 45. 5%- 100%). Conclusion From 2012 to 2014,the infection rate of Gram positive coccus in bloodstream infection was decline,while Gram negative bacillus infection rose. The drug resistance rate has increased year by year. The resistant monitoring and rational use of antibiotics are very important for controlling the occurrence and development of antimicrobial resistance.