2011-2016年临床常见血培养分离病原菌的菌群分布及耐药性变迁

目的:分析医院血培养检出细菌的菌群分布及耐药性变迁，为临床治疗用药提供参考。方法:收集医院2011-2016年间血培养阳性的数据，依据CLSI2014年标准，用WHONET5.6软件对其进行回顾性分析。结果:血培养分离出的菌株中革兰阴性菌依次为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、阴沟肠杆菌、鲍曼不动杆菌。阳性菌依次为凝固酶阴性的葡萄球菌、金黄色葡萄球菌、屎肠球菌、粪肠球菌。主要分布在重症医学科、老年病房、普外科、血液科。据6年的药敏结果可见，除铜绿假单胞菌对亚胺培南的耐药率有下降以外，其他革兰阴性常见菌对头孢哌酮舒巴坦及碳青霉烯类抗生素的耐药性基本都呈上升趋势。常见革兰阳性球菌对红霉素的耐药率均大于50%。屎肠球菌对大多数测试药物的耐药率均较高。除粪肠球菌和金黄色葡萄球菌外，革兰阳性常见菌对青霉素类药物耐药率均大于80%。共发现30株耐亚胺培南的肠杆菌，1株耐万古霉素的屎肠球菌。结论:密切关注血流感染常见菌的菌群分布、耐药情况、耐药性变迁，可为临床感染早期合理使用抗生素及防控耐药菌株的暴发流行提供帮助。

Distribution and antibiotic resistance changes of common pathogenic bacteria separated from clinical blood cultures from 2011 to 2016

Objective: To investigate the pathogenic bacterial distribution and antibiotic resistance changes in blood cultures and provide guidelines for clinical treatment. Methods:The positive blood culture data in Tianjin Medical University General Hospital between 2011 and 2016 were collected and retrospectively analyzed using WHONET (Version 5.6) software according to the CLSI criteria, 2014. Results: Among the bacteria separated from blood cultures, the Gram-negative bacteria were Escherichia coli, Klebsiellapneumoniae, Pseudomonas aeruginosa, Enterobacter cloacae and AcinetobacterBaumanii, while Gram-negative bacteria comprised coagulase-negative Staphylococcus, Staphylococcus aureus, Enterococcus faecium and Enterococcus faecalis. They mainly distributed in intensive care unit, geriatric ward, department of general surgery and department of hematology. The drug sensitivity results in our hospital in the past 6 years showed that resistance of common Gram-negative bacteria to cefoperazone-sulbactam and carbapenems was rising, except that resistance of Pseudomonas aeruginosa to imipenem decreased. The resistance rates of common Gram-positive bacteria to erythromycin were higher than 50%. Moreover, the resistance rates of Enterococcus faecium to most tested antibiotic drugs were high. Except Enterococcus faecalis and Staphylococcus aureus, the resistance rates of most Gram-positive bacteria to penicillins were higher than 80%. A total of 30 imipenem-resistant enterobacteria strains and 2 vancomycin-resistant Enterococcus faecium strains were found. Conclusion: The bacteria distribution and drug resistance changes of common bacteria in bloodstream infection should be paid close attention to so as to provide guidelines for rational use of antibiotics at the early stage of infection and outbreak control of drug-resistant bacteria.