280例血培养阳性标本细菌分布及耐药性分析

目的了解本院血培养阳性标本细菌分布及耐药情况。方法总结2006年7月至2008年6月本院门诊、住院患者送检的血培养阳性标本,采用VITEK32全自动细菌分析仪进行鉴定及药敏试验。结果280例血培养阳性标本中革兰阳性菌200例,占71．4％,以凝固酶阴性葡萄球菌、金黄色葡萄球菌为主,对第1代头孢耐药率较高;革兰阴性菌80例,占28．6％,以大肠埃希菌、克雷伯菌属为主。结论血培养分离的病原菌以革兰阳性茼为主,病原菌种类较多,耐药率较高。掌握败血症主要病原菌的耐药性对指导临床用药有一定的作用。     

住院儿童血培养病原菌分布及耐药性分析

目的了解浏阳地区住院儿童血培养病原菌的分布及耐药情况。方法回顾性分析2006年3月至2010年3月浏阳市某医院住院患儿送检的血培养阳性标本,采用VITEK32全自动细菌分析仪进行病原学鉴定及药敏试验。结果 6 050份血培养标本共分离出病原菌652株,阳性率为10.8%,其中革兰阳性菌413株,占63.3%,以凝固酶阴性葡萄球菌和金黄色葡萄球菌为主;革兰阴性杆菌217株,占33.3%,以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌为主。结论住院儿童血培养分离的病原菌以革兰阳性菌为主,临床上应重视住院儿童血培养病原菌的耐药情况,加强耐药性监测,合理使用抗菌药物。     

儿童血培养病原菌分布及耐药性分析

目的 回顾性分析该院2010年1月至2011年12月儿童血培养病原菌分布和耐药性特点,为该院儿童血流感染抗菌药物使用提供依据.方法 血培养采用BACTEC自动化血培养仪,菌株鉴定使用VITEK-32细菌鉴定系统或API鉴定系统.结果 2 134例血培养标本中共分离210株细菌,其中革兰阳性菌株157株(占74.76%),革兰阴性菌株53株(占25.24%).耐甲氧西林金黄色葡萄球菌占金黄色葡萄球菌56.12%,耐甲氧西林凝固酶阴性葡萄球菌占凝固酶阴性葡萄球菌79.07%,未检出耐万古霉素、替考拉宁革兰阳性球菌;大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶分别占55.56%、46.15%,未检出耐碳青霉烯革兰阴性细菌.结论 该院儿童血培养主要病原菌为革兰阳性菌,且耐药株比例较高,重视抗菌药物的合理使用刻不容缓.     

3126例血培养结果的细菌学分布及耐药性分析

目的 统计分析2008～2010年3 126例血培养标本中分离的病原菌分布及耐药情况,指导临床合理使用抗生素.方法 采用全自动血培养仪Bact/Alert 120及专用血培养瓶,阳性血培养转种血/中国兰培养基和巧克力培养基,细菌鉴定采用VITEK 2 COMPACT全自动细菌分析仪,药敏试验采用K-B法.结果 血培养阳性率为16.86%,检出致病菌共527株,革兰阳性球菌以凝固酶阴性葡萄球菌和金黄色葡萄球菌占优势,革兰阴性杆菌以大肠埃希菌和肺炎克雷伯菌居多,真菌以白色念珠菌居多;凝固酶阴性葡萄球菌和金黄色葡萄球菌对万古霉素、替考拉宁、阿米卡星、米诺环素较敏感,大肠埃希菌和肺炎克雷伯菌对亚胺培南、美洛培南、哌拉西林/他唑巴坦和阿米卡星较敏感.结论 河北省邯郸市中心医院血液标本细菌检出率较高,以革兰阳性菌为主,抗生素耐药率高.了解血液感染细菌的分布特征和耐药性,对减少院内感染,指导临床合理使用抗生素有重要意义.     

武汉市青山区血培养病原菌的分布及耐药性分析

目的了解本地区阳性血培养病原菌分布及耐药性。方法运用全自动血培养系统对1315份血培养标本进行培养,125例阳性,对培养阳性进行细菌鉴定和药敏试验。结果血培养125例阳性,阳性率为9.5%;G-杆菌63株占50.4%,以大肠埃希菌及肺炎克雷伯菌为主;G＋球菌59株占47.2%,以表皮葡萄球菌、金黄色葡萄球菌为主;真菌3例占2.4%,以白假丝酵母菌为主。药敏结果：葡萄球菌对万古霉素、复方新诺明、呋喃妥因的敏感率均高于80%,但耐甲氧西林葡萄球菌的耐药率较高。产ESBLs大肠埃希菌和产ESBLs肺炎克雷伯菌及铜绿假单胞菌、不动杆菌有较高耐药率。结论血培养有一定阳性率,以大肠埃希菌、肺炎克雷伯菌和葡萄球菌为主,均有较高耐药率,临床应及时送检血培养,依据药敏结果选用抗菌药物进行治疗。     

武汉市青山区血培养病原菌的分布及耐药性分析

目的了解本地区阳性血培养病原菌分布及耐药性。方法运用全自动血培养系统对1315份血培养标本进行培养,125例阳性,对培养阳性进行细菌鉴定和药敏试验。结果血培养125例阳性,阳性率为9.5%;G-杆菌63株占50.4%,以大肠埃希菌及肺炎克雷伯菌为主;G+球菌59株占47.2%,以表皮葡萄球菌、金黄色葡萄球菌为主;真菌3例占2.4%,以白假丝酵母菌为主。药敏结果:葡萄球菌对万古霉素、复方新诺明、呋喃妥因的敏感率均高于80%,但耐甲氧西林葡萄球菌的耐药率较高。产ESBLs大肠埃希菌和产ESBLs肺炎克雷伯菌及铜绿假单胞菌、不动杆菌有较高耐药率。结论血培养有一定阳性率,以大肠埃希菌、肺炎克雷伯菌和葡萄球菌为主,均有较高耐药率,临床应及时送检血培养,依据药敏结果选用抗菌药物进行治疗。     

高原低氧环境下烧伤科患者创面普通培养细菌分布特点和耐药性分析

目的 探讨高原低氧环境下烧伤科患者创面普通培养细菌分布特点及耐药性,为高原烧伤科患者抗感染治疗提供参考依据。方法 选取2018-2021年该院烧伤科患者的创面普通培养细菌阳性标本362份为研究对象。对分离菌株进行鉴定和药敏试验;分析患者创面的细菌分布特点;分析检出的主要革兰阳性菌及革兰阴性菌的耐药情况;分析2018-2021年各年检出的主要革兰阳性菌和革兰阴性菌分布及耐药率变化。结果 普通培养细菌阳性的362份标本中,检出革兰阳性菌236株(65.19%),以金黄色葡萄球菌、表皮葡萄球菌占比较高(37.02%、12.98%);检出革兰阴性菌126株(34.81%),以大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌占比较高(11.60%、5.80%、5.25%)。金黄色葡萄球菌对青霉素、红霉素和克林霉素的耐药率较高,对左氧氟沙星、氯霉素、利福平的耐药率较低;分离出的金黄色葡萄球菌中,耐甲氧西林金黄色葡萄球菌占65.67%。表皮葡萄球菌对青霉素、红霉素和克林霉素的耐药率较高;分离出的表皮葡萄球菌中,耐甲氧西林表皮葡萄球菌占70.21%。大肠埃希菌对头孢唑啉、氨苄西林和哌拉西林的耐药率较高,对亚胺培...     

612例血培养标本的细菌分布和耐药情况分析

目的了解本院血培养阳性标本中分离的病原菌分布及耐药情况,指导临床合理使用抗生素。方法对本院612例血培养标本所进行的细菌培养及药敏检测进行回顾性分析。结果共检出阳性血培养标本71例,菌株74株,其中革兰阳性菌46株、阴性菌28株,占总数的62．2％和37．8％,革兰阳性菌以金黄色葡萄球菌、凝固酶阴性葡萄球菌为主,对万古霉素、头孢哌酮／舒巴坦、亚胺培南较敏感,革兰阴性菌以大肠埃希菌、肺炎克雷伯菌为主,对亚胺培南、头孢哌酮－舒巴坦、氨曲南较敏感。结论血培养分离的病原菌以革兰阳性菌为主,抗生素耐药率高,临床应加强疑为败血症患者的血培养标本检测,尽早准确合理应用抗生素,提高治愈率。     

2016—2018年11所医院儿童血培养分离菌的耐药性分析

目的了解2016-2018年11所医院儿童血培养阳性细菌的分布及耐药情况。方法根据全国细菌耐药监测网技术要求,对血培养阳性分离菌进行鉴定和药敏试验,按照2018年美国临床和实验室标准化协会(CLSI)标准进行结果判读,用WHONET 5.6软件对数据进行统计分析。结果2016-2018年自血培养中共分离得病原菌14078株,其中革兰阳性菌9141株,占64.9%;革兰阴性菌4937株,占35.1%,前五位分离菌依次为凝固酶阴性葡萄球菌、大肠埃希菌、嗜麦芽窄食单胞菌、克雷伯菌属和肠球菌属细菌。金黄色葡萄球菌和凝固酶阴性葡萄球菌中甲氧西林耐药株(MRSA、MRCNS)的检出率分别为31.6%和81.4%。除四环素外,粪肠球菌对其他抗菌药物的耐药率均低于屎肠球菌,肺炎链球菌对青霉素G的耐药率仅为1.6%,未检出耐万古霉素和利奈唑胺的细菌。碳青霉烯类耐药大肠埃希菌和肺炎克雷伯菌检出率分别为4.4%和21.5%。结论儿童血培养分离菌以革兰阳性菌为主,MRSA仍然是革兰阳性菌感染中的主要问题。碳青霉烯类耐药的肠杆菌科细菌逐年增加,应加强医院感染防控和抗菌药物临床应用管理,以遏制此类菌株的传播扩散。     

肿瘤专科医院血培养病原菌分布及耐药性研究

目的了解医院血培养病原菌分布及耐药情况。方法通过细菌分离培养和药敏试验方法,对医院血培养病原菌分布及其耐药性进行调查与分析。结果从9681套肿瘤患者血培养标本中分离出847株病原菌,革兰阴性菌占66.59%,其中大肠埃希菌占38.02%,肺炎克雷伯菌占13.11%;革兰阳性菌占29.63%,其中人型葡萄球菌及表皮葡萄球菌占7.91%,金黄色葡萄球菌占5.79%。大肠埃希菌对氨苄西林耐药率大于70.00%,葡萄球菌对青霉素高度耐药,耐甲氧西林金黄色葡萄球菌约占25.00%。结论肿瘤患者血流感染致病菌基本以革兰阴性菌为主,多数病原菌严重耐药。     

80株深部真菌感染阳性血培养及药敏结果分析

目的　分析 80株血培养真菌阳性标本及其药敏结果 ,寻找深部真菌感染特点。方法　血培养使用Back/Alert血培养仪。分离使用科玛嘉培养基。真菌和细菌鉴定使用VitekAMS 6 0微生物分析仪。药敏使用微量MIC法。HCMV检验使用PCR和RT PCR方法。结果　 80株真菌分布在 4个菌属中 ,以念珠菌属为主占 91 2 5%。获得阳性结果时间平均 31 80h ,72h内获得结果者 76株占 95 0 %。对 5种真菌作药敏试验 ,5 氟胞嘧啶敏感率最高 ( 97% ) ,特比奈芬最低 ( 35% )。 51 2 5%( 4 1 /80 )患者从血以外的其他标本获得与血中分离菌种一致的真菌。 80例患者中 4 6例伴随有细菌或病毒感染 ,占患者57 50 %。真菌感染多见于免疫功能低下者 ,本组 80例患者中各种肿瘤占 6 9例 ( 86 2 5% )。结论　血培养阳性是患者深部真菌感染的确证依据 ,多为在免疫功能低下者发生的院内感染 ,多系统真菌感染多为临床致死原因。真菌药敏实验结果给临床治疗提供了有参考价值的信息     

Frequency and yield of blood cultures for observation patients with skin and soft tissue infections

Objectives1) To measure frequency and yield of blood cultures obtained for observation status adult patients with skin and soft tissue infection (SSTI), 2) describe how often blood cultures were performed according to Infectious Diseases Society of America (IDSA) SSTI guideline indications, 3) identify proportion of patients meeting Center for Medicare Services (CMS) sepsis criteria.DesignRetrospective cohort.SettingTertiary academic center.PatientsConsecutive adult observation status patients hospitalized with SSTI between July 2017 and July 2018.MethodsWe measured the proportion and results of blood cultures obtained among the study cohort and proportion of obtained cultures that satisfied IDSA indications.ResultsWe identified 132 observation status patients with SSTI during the study period; 67 (50.8%) had blood cultures drawn. Only 14 (10.6%) patients met IDSA indications for culture; 51 (38.%) met Center for Medicare Services definition for sepsis. We identified two (3.0%) cases of bacteremia and two (3.0%) cases of skin bacteria contamination. In multivariable analysis, only temperature > 38 °C (OR 3.84, 95%CI 1.09–13.60) and white race (OR 2.71, 95%CI 1.21–6.20) were associated with blood culture obtainment; neither meeting IDSA SSTI guideline indications nor meeting CMS sepsis criteria was associated with culture.ConclusionsAmong observation status patients with SSTI, over half had blood cultures drawn, though 10% satisfied guideline indications for culture. The proportion of cultures with bacterial growth was low and yielded as many skin contaminants as cases of bacteremia. Our study highlights the need for further quality improvement efforts to reduce unnecessary blood cultures in routine SSTI cases.     

Prior colonization is associated with increased risk of antibiotic-resistant Gram-negative bacteremia in cancer patients

We hypothesized that prior colonization with antibiotic-resistant Gram-negative bacteria is associated with increased risk of subsequent antibiotic-resistant Gram-negative bacteremia among cancer patients. We performed a matched case-control study. Cases were cancer patients with a blood culture positive for antibiotic-resistant Gram-negative bacteria. Controls were cancer patients with a blood culture not positive for antibiotic-resistant Gram-negative bacteria. Prior colonization was defined as any antibiotic-resistant Gram-negative bacteria in surveillance or non-sterile-site cultures obtained 2–365 days before the bacteremia. Thirty-two (37%) of 86 cases and 27 (8%) of 323 matched controls were previously colonized by any antibiotic-resistant Gram-negative bacteria. Prior colonization was strongly associated with antibiotic-resistant Gram-negative bacteremia (odds ratio [OR] 7.2, 95% confidence interval [CI] 3.5–14.7) after controlling for recent treatment with piperacillin-tazobactam (OR 2.5, 95% CI 1.3–4.8). In these patients with suspected bacteremia, prior cultures may predict increased risk of antibiotic-resistant Gram-negative bacteremia.     

Algorithm for the identification of bacterial pathogens in positive blood cultures by real-time LightCycler polymerase chain reaction (PCR) with sequence-specific probes

We developed real-time polymerase chain reaction (PCR) assays for rapid detection of the most common and clinically relevant bacteria in positive blood culture bottles, including Staphylococcus spp., S. epidermidis, S. aureus, Enterococcus spp. (including differentiation of E. faecalis and E. faecium), Streptococcus spp., Streptococcus agalactiae, Enterobacteriaceae, E. coli, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Acinetobacter spp., Bacteroides spp., Haemophilus influenzae, and Neisseria meningitidis. A total of 507 positive blood cultures were investigated according to a specific PCR algorithm based on the microscopic result of the blood culture, and the PCR results were compared to the culture results. Apart from-cross reactions between E. coli and Chryseomonas luteola and Enterococcus faecium and E. durans, the PCR assay correctly identified all bacteria in the blood cultures and did not show any false-positive results. Regarding blood cultures positive with a single species of bacteria (n = 474), 98.3% of all bacteria were correctly detected by the PCR algorithm within a few hours. However, in mixed infections, the sensitivity was lower. The PCR algorithm is well suited for rapid identification of the most common bacteria in positive blood cultures.     

The yield of blood cultures in a department of emergency medicine.

This study sought to determine the yield of blood cultures drawn in the department of emergency medicine. The results of 730 blood cultures taken from 718 patients were retrospectively analysed. The total percentage of positive cultures was 9.7%. Only 3.4% of the blood cultures were classified as true bacteraemia and the rest as contaminants. The commonest type of isolate was coagulase-negative staphylococci (49%), which were considered contaminants in all cases. Other contaminants represented 13.2% of all the positive blood cultures. The following bacteria comprised the group of true bacteraemia: Escherichia coli (12.6%), Streptococcus pneumoniae (9.8%), viridans streptococci (7%), Staphylococcus aureus (2.8%), Bacteroides fragilis (2.8%), Moraxella species (1.4%) and Flavobacterium species (1.4%). Blood cultures were positive in 3.6% of patients with pneumonia and in 10% of patients with urinary tract infections. In patients with fever of unclear source blood cultures were positive in 3.1% of children between 0-36 months of age and in 1.1% of patients older than 16 years. As a whole, patients with positive blood cultures were clinically sicker, a higher percentage of them required admission to the hospital and had higher temperatures or rapidly fatal disease, compared with the group of patients with negative blood cultures. In order to improve the yield of blood cultures in febrile patients, first, better a priori identification of those subjects at high risk for bacteraemia will reduce the number of unnecessary blood cultures and second, sterile venipuncture techniques should be improved in order to reduce the number of contaminants.     

血培养阳性病原菌仪器报警时间分析

目的:分析血培养阳性病原菌仪器(BacT/Alert3D血培养仪)报警时间。方法:收集南京医科大学第一附属医院2010年血培养阳性的报警时间及相应的病原菌鉴定结果,计算各常见病原菌阳性报警的中位时间。结果:2010年标本中有419份阳性,革兰阳性细菌占56.8%,革兰阴性细菌占39.4%,真菌占3.8%。对血培养阳性仪器报警时间进行分析,≤12h、≤24h、≤48h报警的病原菌分别为154株(36.8%)、281株(67.1%)、373株(89.0%)。血培养阳性病原菌仪器报警中位时间分别为:肠杆菌科细菌(10.2h)、非发酵菌(12.2h)、链球菌属(15.0h)、肠球菌属(12.7h)、葡萄球菌(23.1h)、真菌(39.9h)。结论:血培养阳性报警时间从早到晚依次是:肠杆菌科细菌、非发酵菌属、肠球菌属、链球菌属、葡萄球菌属、真菌。引起血液系统感染的病原菌均在5d内得到仪器的阳性报警,大多数病原菌在2d内报警阳性。     

Detection of bacterial contamination of platelet components: six years' experience with the BacT/ALERT system

BACKGROUND: Hemovigilance has shown that bacteria cause more fatalities than other infections together. Surveillance for detection of bacteria in platelets (PLTs) was initiated. Concomitantly, the storage period for PLTs was extended from 5 to 7 days to reduce cost. STUDY DESIGN AND METHODS: Analysis was performed of all cases of a positive signal in a screening procedure for contaminated PLTs taking into account results of confirmative cultures and results of culture from blood components including bacteria strains. Records were assessed from patients transfused with blood components issued before the screening culture became positive. RESULTS: Samples were collected from 22,057 PLT units. An initial reaction was seen in 84 (0.38%). Growth was confirmed in 70 of these. Of the associated PLT units, 26 had been issued or outdated at the time when the culture was found to be reactive, in 27 bacteria were found, and in 17 cultures were negative. The bacteria found were mainly from normal skin flora. Sixty-six patients received 75 blood components issued before the screening system alarmed. None of these patients had a transfusion reaction reported. The outdating fell to less than 5 percent. CONCLUSION: A screening system for detection of bacterial contamination was implemented without increase in cost owing to extension of storage time to 7 days. Transfusion of several contaminated blood components was prevented.     

Clinical and microbiological characteristics in cases of positive blood cultures at Shin-Kokura Hospital during a period of 5 years

In order to evaluate the present state of bacteremia, we investigated the clinical and microbiological characteristics of positive blood culture cases hospitalized in Shin-Kokura Hospital from January 1998 through December 2002. Seventy-five cases showed positive blood cultures during the 5 years, and 48 cases (64%) were 70 years old or more. Most of the cases had underlying diseases, such as malignancy. The diagnoses of the infectious diseases found included pneumonia (9 cases), enteric infection (9 cases), hepatobiliary infection (8 cases), urinary tract infection (8 cases), and endocarditis (6 cases). A total of 102 strains of microorganism were isolated, and Gram-positive bacteria accounted for 64.7% of the cases, with Gram-negative bacteria accounting for 29.4%. Most of the isolated microorganisms showed good susceptibility to antimicrobial agents except for MRSA. Antimicrobial agents were used for 54 cases of bacteremia, and 33 patients improved, but 21 patients died, including 10 whose death was due to infection. In this study, the 54 cases of bacteremia (72% of all cases with a positive blood culture) showed a mortality rate of 18.5% due to infection, in spite of adequate antimicrobial treatment. Our data suggest that physicians should recognize the difficulty of treating bacteremia, and should pay close attention to the physical condition of patients with bacteremia.     

Emergence of MRSA in positive blood cultures from patients with febrile neutropenia—a cause for concern

GOALS OF WORK: Febrile neutropenia (FN) causes considerable morbidity in patients on cytotoxic chemotherapy. Recently, there has been a trend towards fewer Gram-negative and more Gram-positive infections with increasing antibiotic resistance. To assess these patterns, data from a supra-regional cancer centre in Ireland were reviewed. PATIENTS AND METHODS: A 5-year review of all positive blood cultures in patients undergoing anti-cancer chemotherapy was carried out. MAIN RESULTS: Eight hundred and ninety-four patients were reviewed. The mean incidence of FN was 64.2 cases per year. Eight hundred and forty-six blood culture specimens were taken and 173 (20.4%) were culture positive. The isolated organisms were Gram positive (71.1%), Gram negative (27.8%) and fungal (1.1%). Of the Gram-positive organisms, 75.6% were staphylococci. Of these, 67.8% were coagulase-negative staphylococci and 30.1% were Staphylococci aureus. Amongst the S. aureus, 89.3% were methicillin-resistant (MRSA). Vancomycin-resistant enterococci were not identified as a cause of positive blood cultures. CONCLUSIONS: Amongst patients with cancer who develop FN in our hospital, Gram-positive bacteria account for the largest proportion. The high proportion of MRSA as a cause of positive blood cultures is of concern.