某县级医院连续4年血培养分离病原体及其耐药性

目的了解某县级医院送检血培养标本分离的病原体分布及其耐药性。方法对该院2008-2011年收集的血培养标本分离的病原体资料进行回顾性分析。结果4年1 780份血培养标本共分离病原体285株，阳性率为16.01%。其中革兰阳性（G+）球菌155株（54.39%），以金黄色葡萄球菌（84株，29.48%）和凝固酶阴性葡萄球菌（38株，12.28%）分离率较高；革兰阴性（G-）杆菌103株（36.14%），以大肠埃希菌（43株，15.09%）、铜绿假单胞菌（19株，6.67%）和肺炎克雷伯菌（13株，4.56%）分离率较高；真菌27株（9.47%），以白假丝酵母菌分离率（13株，4.56%）较高。G+球菌耐药率较高，但所有菌株对万古霉素和替考拉宁敏感；金黄色葡萄球菌中，耐甲氧西林株占40.48%，凝固酶阴性葡萄球菌中，耐甲氧西林株占57.14%。G-杆菌对亚胺培南、美罗培南及含酶抑制剂的抗菌药物较敏感；共检出产超广谱β 内酰胺酶菌31株，其中大肠埃希菌25株（58.14%），肺炎克雷伯菌6株（46.15%）。结论该县级医院血培养分离病原体以G+菌为主，耐药性较高，临床医生应根据药敏试验结果合理用药，以减轻抗菌药物的选择性压力。

Distribution and antimicrobial resistance of pathogens isolated from blood culture in four consecutive years at a county level hospital

ObjectiveTo investigate the distribution and antimicrobial resistance of pathogens isolated from blood culture from a hospital.MethodsData of pathogens isolated from blood specimens between 2008 and 2011 were analyzed retrospectively.ResultsA total of 285 pathogenic isolates were obtained from 1 780 specimens, positive rate was 16.01%. The number of gram positive cocci were 155 isolates（54.39%）,the major were Staphylococcus aureus （84 isolates，29.48%）and coagulase negative Staphylococcus （38 isolates，12.28%）; the number of gram negative bacilli were 103 isolates(36.14%),the major were Escherichia coli（43 isolates，15.09%）,Pseudomonas aeruginosa（19 isolates，6.67%）,and Klebsiella pneumoniae（13 isolates，4.56%）;the number of fungi was 27 isolates (9.47%),the major was Candida albicans(13 isolates,4.56%).The resistant rate of gram positive cocci was high, but all strains were sensitive to vancomycin and teicoplanin, 40.48% of Staphylococcus aureus and 57.14% of coagulase negative Staphylococcus were methicillin resistant. Gram negative bacilli were sensitive to imipenem, meropenem,and enzyme inhibitor containing antimicrobial drugs; 31 extended spectrum β lactamase producing isolates were detected, 25（58.14%） of which were Escherichia coli， 6（46.15%）were Klebsiella pneumoniae.ConclusionThe major pathogens isolated from blood culture from this hospital are gram positive bacteria, and antimicrobial resistance is high, clinicians should choose antimicrobial agents according to antimicrobial susceptibility testing results, so as to reduce the emergence of resistant strains.