西藏地区败血症患者血液中病原菌分布及耐药性分析

目的：了解高原地区医院感染败血症患者血液中病原菌的分布及耐药特征。方法血液培养采用BD BACTEC 9120全自动血培养仪，细菌的鉴定和药敏试验利用BD Phoenix仪和K-B法药敏试验。数据分析用WHONET 5.4和Excel 2003软件。结果452例外周血标本中检出74株（16.3%）病原菌，从中分离出革兰阴性菌27株（36.4%），革兰阳性菌39株（52.7%），真菌8株（10.8%）。引起败血症的主要病原菌依次为葡萄球菌（25株，33.8%）、屎肠球菌（9株，12.2%）、大肠埃希菌（7株，9.5%）；对革兰阳性菌药敏耐药性相对较低的药物为氯霉素和万古霉素。对革兰阴性菌药敏耐药性较低的药物为亚胺培南、环丙沙星和阿米卡星。结论革兰阳性菌是高原地区败血症的主要致病菌。葡萄球菌是最常见的病原菌，肠球菌属和大肠埃希菌次之。病原菌对临床抗菌药物有较高的耐药性。万古霉素和亚胺培南分别为革兰阳性和阴性菌最为敏感的抗菌药物。

Distribution and drug resistance of pathogens isolated from patients with septicemia in Tibet

Objective To analyze the distribution and drug resistance of pathogens isolated from septicemia patients in Tibet. Methods The blood samples of inpatients were cultured with blood culture apparatus. The isolated bacteria were identified with BD Phoenix apparatus, and the drug resistance tests were conducted with K-B method. WHONET 5.4 and Excell2003 were applied for data analysis. Results Among the 452 samples, 74 （16.3%） strains of pathogens were isolated, 27 （36.4%） were Gram-negative bacteria, 39 （52.7%） were Gram-positive bacteria and 8 （10.8%） were fungi. The most common pathogens were Staphylococcus （25 strains, 33.8%）, Enterococcus faecium （9 strains, 12.2%） and Escherichia coli （7 strains, 9.5%）. The drugs with low resistance to Gram-positive bacteria were vancomycin and chloramphenicol. And the drugs with low resistance to Gram-negative bacteria were imipenem, ciprofloxacin and amikacin. Conclusions The Gram-positive bacteria were the predominant pathogen of septicemia. The Staphylococcus was the most common one, the Enterococcus faecium and Escherichia coli had a certain proportion. And the pathogenic bacteria had higher resistance clinically to antibiotics. Among all antibiotics, vancomycin and imipenem were the most sensitive ones to Gram-positive bacteria and Gram-negative bacteria, respectively.