8548例血流感染病原菌分布及耐药性分析

目的：分析2012-2013年四川省血流感染患者的病原菌分布特点及耐药特性，为临床合理使用抗菌药物提供依据。方法：收集四川省54家医院临床血培养阳性患者8548例，菌株鉴定到种，药敏试验采用MIC法和纸片扩散法（KB 法），结果按 CLSI2012年版标准判读，用 Whonet 5.6软件进行耐药性分析。结果：8548株菌中，革兰阴性杆菌占51.5%（4407/8548），革兰阳性球菌占45.9%（3929/8548），真菌占2.2%（192/8548），厌氧菌占0.2%（20/8548）。大肠埃希菌分离率最高为26.0%（2223/8548）；其次为肺炎克雷伯菌为8.8%（756/8548）；葡萄球菌中以凝固酶阴性葡萄球菌检出率最高为32.8%（2806/8548）；金黄色葡萄球菌为7.3%（628/8548）。大肠埃希菌和肺炎克雷伯菌对亚胺培南99.7%和98.7%敏感。鲍曼不动杆菌对亚安培南耐药率71.4%。耐甲氧西林金黄色葡萄球菌（MRSA）检出率为30.2%，耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）检出率为66.9%。未发现对万古霉素和利奈唑胺耐药葡萄球菌。凝固酶阴性葡萄球菌和金黄色葡萄球菌对替考拉宁耐药率为3.9%和0.9%。屎肠球菌和粪肠球菌对利奈唑胺耐药率分别为0.8%，0.9%，对万古霉素耐药率分别为4.3%，0.9%，对替考拉宁均未发现耐药株。就绝大多数抗菌药而言，屎肠球菌对抗菌药物的耐药率显著高于粪肠球菌。结论：血流感染菌株以革兰阴性杆菌为主，大肠埃希菌是主要感染细菌，凝固酶阴性葡萄球菌的感染同样不容忽视。

Analysis of Pathogen Distribution and Drug Resistance in 8 548 Case of Bloodstream Infection

Objective： To analyze the characteristics of pathogen distribution and drug resistance in bloodstream infection from 2012 to 2013 in Sichuan province so as to provide the basis for clinical rational use of antimicrobial a-gents . Methods： The samples of 8 548 patients who were clinical blood culture positive were collected from 54 hospi-tals in Sichuan province . Tests were conducted for strain identification and MIC and disc diffusion methods （KB method） were adopted for susceptibility test . The results were interpreted according to the Clinical Laboratory Stan-dards Institute （CLSI , 2012 edition ） , and WHONET 5 . 6 software was used for the analysis of drug resistance . Re-sults： Of 8 548 bacterial strains,gram-negative bacteria and gram-positive cocci accounted for 51.5%（4 407/8 548） and 45.9% （3 929/8 548） respectively, fungi and anaerobic bacteria accounted for 2.2% （192/8 548） and 0.2% （20/8 548）. The separation rate of Escherichia coli and Pneumonia klebsiella bacteria was 26%（2 223/8 548） and 8.8%（756/8 548） re-spectively . The detection rate of coagulase negative Staphylococcus aureus and Staphylococcus aureus was 32 . 8%（ 2 806/8 548 ） and 7 . 3% （ 628/8 548 ） respectively . The sensitivity of Escherichia coli and Klebsiella pneumoniae to imipenem was 99 . 7% and 98 . 7%. The resistance rate of Acinetobacter baumannii to imipenem was 71 . 4%. MRSA de-tection rate was 30 . 2%, while MRCNS detection rate was up to 66 . 9%. No Staphylococcus aureus was found resistant to vancomycin or linezolid . The resistance rate of Coagulase-negative staphylococci and Staphylococcus aureus to te-icoplanin was 3 . 9% and 0 . 9% respectively . The resistance rate of Enterococcus faecium and Enterococcus faecalis to linezolid was 0 . 8% and 0 . 9%, and to vancomycin was 4 . 3% and 0 . 9% respectively . No teicoplanin-resistant strain was found . To most antibiotics , the antibiotic resistance in Enterococcus faecium was significantly higher than in Ente-rococcus faecalis .