血流感染的病原菌分布及耐药性分析

目的：分析2015年1月~2015年12月我院血流感染患者主要病原菌的构成及耐药性，为临床血流感染的诊断与治疗提供依据。方法血液培养采用美国 BD 公司 Bactec FX 型和法国梅里埃公司 Bact/ Alert 3D 240型血培养仪；细菌鉴定采用德国 Walkway 96 Plus 和法国梅里埃 API 鉴定系统；抗菌药物敏感试验分别采用 Micro Scan药敏板联合 K-B 纸片扩散法；药物敏感性结果统计分析采用 Whonet 5.6软件。结果血流感染患者中革兰阳性菌检出率为34.55%，革兰阴性菌检出率为63.11%，其中革兰阴性杆菌主要为大肠埃希菌（31.69%）和肺炎克雷伯菌（8.83%），革兰阳性菌主要为表皮葡萄球菌（8.05%）和金黄色葡萄球菌（7.53%）；葡萄球菌、肠球菌和肺炎链球菌对万古霉素、利奈唑胺100%敏感，对红霉素和克林霉素耐药率均高于70%；大肠埃希菌、肺炎克雷伯菌、弗氏枸橼酸杆菌和阴沟肠杆菌对亚胺培南和美罗培南100%敏感，铜绿假单胞菌对亚胺培南和美罗培南耐药率均为15.4%，大肠埃希菌和肺炎克雷伯菌对头孢曲松的耐药率分别47.5%和32.4%，对左氧氟沙星的耐药率分别51.6%和20.6%。结论我院血流感染病原菌以革兰阴性菌为主，大肠埃希菌和凝固酶阴性葡萄球菌耐药严重，临床应重视血培养标本送检和细菌耐药监测，合理使用抗菌药物。

Analysis of the distribution and drug resistance of pathogenic bacteria of bloodstream infections

Objective To get information about bacterial distribution and resistance in bloodstream infection.Methods Various clinical department blood cultures samples were collected by Bactec FX and Bact/ Alert 3D 240.The identification and antimicrobial susceptibility testing were performed with Walkway 96 Plus and API,Statistical analysis was done with Whonet 5.6.ResuIts A total of 385 bacterial strains were isolated,and gram negative bacteria accounted for 63.11%,of which Escherichia coli accounted for 31.69%,followed by Klebsiella pneumonia 8.83%,the gram positive bacteria accounting for 34.55%,of which Staphylococcus epidermidis accounted for 8. 05%,followed by staphylococcus aureus accounted for 7. 53%.The resistant rates of Staphylococcus,Enterococcus and Streptococcus pneumoniae to vancomycin,linezolid were 0;No imipenem and meropenem resistant Escherichia coli and Klebsiella pneumonia were found.ConcIusion Gram-negative ba-cilli were the major pathogens of BSI;Antibiotic resistance becomes more prevalent in some major pathogens.Rational use of antibiotics is important for the containment of bacterial resistance.