某三级医院连续4年血培养分离菌构成及耐药性

目的了解血培养病原体的分布及其耐药性，为临床合理用药提供依据。方法对某院2008年1月-2011年12月间门诊及住院患者血培养标本分离的非重复病原体资料进行统计分析。结果670株血培养病原体中，革兰阴性杆菌306株（45.67％），革兰阳性球菌329株（49.11％），真菌35株（5.22%）；检出率居前3位的病原菌依次为凝固酶阴性葡萄球菌（23.88%）、大肠埃希菌（19.40%）和金黄色葡萄球菌（12.98%）。药敏结果显示，血流感染的多重耐药葡萄球菌对复方磺胺甲口恶唑、利奈唑胺及万古霉素的敏感性（耐药率为0～20.34%）高。革兰阴性杆菌（不动杆菌属除外）对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦及阿米卡星的耐药率为0～27.27%；耐药率最高的革兰阴性菌为不动杆菌属。血培养真菌分离率较高的为近平滑假丝酵母菌（2.38%）及白假丝酵母菌（1.79%）。结论早期送血培养做病原学检查，重视血培养分离的多重耐药菌株并加强监测，可及时为临床诊断和治疗提供可靠依据。

Distribution and antimicrobial resistance of pathogens isolated from blood culture in consecutive four years

ObjectiveTo investigate the distribution and antimicrobial resistance of pathogens from blood culture, and to guide the rational use of antimicrobial agents.MethodsData of pathogens from blood specimens of inpatients and outpatients in a hospital between January 2008 and December 2011were analyzed statistically.ResultsOf 670 pathogenic isolates from blood culture, gram negative bacilli, gram positive cocci and fungi accounted for 45.67%(n=306),49.11% (n=329) and 5.22%(n=35) respectively; the top 3 were Coagulase negative staphylococcus(23.88%), Escherichia coli(19.40%) and Staphylococcus aureus(12.98%).Susceptibility of multidrug resistant Staphylococcus to compound sulfamethoxazole, linezolid and vancomycin were relatively high (resistant rate were 0-20.34%).The resistant rates of gram negative bacilli (except Acinetobacter spp.) to cefoperazone/sulbactam,piperacillin/ tazobactam and amikacin were 0-27.27%. Acinetobacter spp. had the highest resistant rate. The most common fungus in blood culture were Candida parapsilosis (2.38%) and Candida albicans(1.79%).ConclusionEarly blood culture and monitor on multidrug resistant pathogenic isolates can provide reliable evidence for clinical diagnosis and treatment.