1580例血流感染患者病原学分析

目的：了解我院2012年1月-2014年10月近3年血流感染患者病原学特征，为临床针对血流感染的治疗提供可靠依据。方法：对1580份患者血培养标本经Bactec 9120全自动血培养仪和Phoenix-100型全自动微生物分析仪进行培养和鉴定药敏。结果：近3年间血培养共分离出1580株病原菌，各科室检出病原菌较多的是中心ICU（399株，25%），神经外科（336株，21%），血液内科（207株，13%）。其中革兰阴性菌（875株，55.4%），革兰阳性菌（614株，38.9%），真菌（91株，5.7%）。检出率位于前5位的分离菌依次为大肠埃希菌（264株，16.71%）、肺炎克雷伯菌（189株，11.96%）、鲍曼不动杆菌（115株，7.28%）、金黄色葡萄球菌（94株，5.95%）、洋葱伯克霍尔德菌（75株，4.75%）。药敏试验显示，金黄色葡萄球菌、表皮葡萄球菌、人葡萄球菌对万古霉素、利奈唑胺敏感率均为100%，耐甲氧西林金黄色葡萄球菌（77株，81.9%），对β-内酰胺类、喹诺酮类、氨基苷类抗菌药呈多重耐药。 D-试验阳性菌株数（249株，66%）。革兰阴性菌的大肠埃希菌对多黏菌素（0%）、头孢哌酮-舒巴坦（0%）、亚胺培南（1%）、美洛培南（1%）较敏感，对其他常见的抗菌药都存在不同程度的耐药。结论：血培养分离的病原菌种类较多，耐药性差异较大，对血培养分离株进行早期监测和耐药性分析非常必要，可为临床医生合理应用抗菌药物提供重要依据，避免滥用抗菌药，减少不合理的经验性治疗。

Analysis of the Etiology of Bloodstream Infection in 1 580 Cases

Objective：To analyze the etiology characteristics of the patients with bloodstream infection in our hospital from Jan. of 2012 to Oct. of 2014 so as to provide medication basis for the clinical treatment of blood-stream infection.Methods：Blood specimens from 1 580 patients were cultured in Bactec 9120 automatic blood culture machine and the drug resistance was identified by the Phoenix-100 automatic microbial analyzer.Results：All of 1 580 strains of pathogenic bacteria were isolated using blood culture method in the three years, of which 399 （25%）pathogenic bacteria were detected by ICU center,336（21%）and 207（13%）were detected by neurosurgery and hematology departments. There were 875 strains of Gram-negative bacteria（55.4%）,614 strains of Gram-positive bacteria（38.9%）and 91 strains of fungi（5.7%）. The top five detection rate of the isolated bacteria wasEscherichia coli（264 strains,16.71%）,Klebsiellapneumoniae（189 strains,11.96%）,Acinetobacterbaumannii（115 strains,7.28%）, Staphylococcusaureus（94 strains,5.95%）andBurkholderiacepacia（75 strains,4.75%）. Drug sensitivity test showed that the sensitive rate ofStaphylococcusaureus,StaphylococcusepidermisandStaphylococcushoministo vancomycin and linezolid was 100%. About 77（81.9%）pathogenic bacteria were drug resistance to methicillin-resistantStaphylo-coccusaureus（MRSA）,and showed multi-drug resistance toβ-lactams,quinolones and aminoglycosides. There were 249（66%）strains of positive bacteria in D-test.Escherichiacoliwhich was Gram-negative was more sensitive to polymyxa streptozotocin（0%）,cefoperazone/sulbactam（0%）,imipenem（1%）and meropenem（1%）,and showed various degree of resistance to other antibacterials.Conclusion：The species of pathogenic bacteria isolated by blood culture method have a wide distribution and have a great difference in drug resistance. Therefore an early detection and drug resistance analysis of pathogenic bacteria isolated from blood culture are very much necessary.