2009～2011年血流感染病原菌分布及耐药性分析

目的探讨2009～2011年我院血流感染病原菌的分布及耐药性以指导用药。方法收集我院2009年1月至2011年12月血培养标本进行分离、培养、鉴定,采用纸片扩散法(Kirby-Bauer法)进行药敏试验,按CLSI2010年公布的标准判断结果。结果共收集近3年血流感染病原菌871株,其中革兰阳性菌528株,占60.62%,革兰阴性菌317株,占36.39%,真菌26株,占2.99%,居前4位的分别是凝固酶阴性葡萄球菌(CNS)、大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)分别占金黄色葡萄球菌和CNS的60.98%和88.60%,产超广谱β内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌分别占大肠埃希菌和肺炎克雷伯菌的61.90%和25.71%。结论血培养中以革兰阳性菌,尤其是CNS占重要地位。细菌耐药情况严重,及时监测细菌耐药情况以指导临床用药。

Distribution and antimicrobial resistance of pathogens in blood culture during 2009-2011

Objective To investigate the distribution and antimicrobial resistance of pathogens isolated from blood culture in our hospital from 2009 to 2011.Methods The blood specimens in the hospital from 2009 to 2011 were routinely incubated,isolated,identified and bacterial susceptibility test was conducted on all isolates using Kirby-Bauer methods with CLSI standards.Results During the 3 years,a total of 871 pathogens were isolated from blood cultures.Of these pathogens,528(60.62%)were gram-positive,317(36.39%)were gram-negative,26(2.99%)were fungi.The most frequent isolates were coagulase negative Staphylococcus(CNS),Escherichia coli,Staphylococcus aureus,and Klebsiella pneumoniae.Fifty of the 82 S.aureus isolates(60.98%)were methicillin resistant S.aureus(MRSA)and 310 of the 350 CNS isolates(88.60%)were methicillin resistant CNS(MRCNS).Extended-spectrumβ-lactamase enzymes were detected in 61.90% of the E.coli isolates and 25.71% of the K.pneumoniae isolates.Conclusions Gram positive cocci,especially CNS,play an important role in bloodstream infection.Antimicrobial resistance of isolated pathogens is prevalent and serious.The study highlights the need for monitoring the change of pathogens and antimicrobial resistance for guiding the clinical therapy.