2008-2014年某医院血流感染病原菌分布 及耐药情况分析

摘要:目的　探讨某院近7年间血流感染病原菌分布及耐药情况，为临床提供相关信息的参考。方法　病人血液标本经全自动血培养仪培养，阳性标本培养后进行菌种鉴定和药物敏感性实验，数据汇总后应用WHONET进行统计分析。结果　7年间该院血流感染的病原菌以革兰阴性菌为主，占47.07%，革兰阳性菌和真菌分别占36.36%和16.60%，68.77%血流感染患者来源于ICU；主要病原菌为大肠埃希菌，表皮葡萄球菌和近平滑念珠菌，分离率分别为13.44%，10.47%和9.29%；大肠埃希菌和肺炎克雷伯菌7年间分离率呈上升趋势，近平滑假丝酵母酵母菌分离率呈下降趋势；革兰阴性菌中，铜绿假单胞菌对常用抗生素表现较高的耐药率，对氨苄西林等7种抗生素耐药率达100%，大肠埃希菌和肺炎克雷伯菌对亚胺培南和哌拉西林/他唑巴坦敏感性好；革兰阳性菌中，耐甲氧西林金黄色葡萄球菌（MRSA）和耐甲氧西林的表皮葡萄球菌（MRSE）的分离率分别为54.17%和77.36%，2种葡萄球菌对青霉素耐药率最高，而对呋喃妥因，利福平和奎奴普丁/达福普汀耐药率较低，均低于20%，未出现耐万古霉素和利奈唑胺的菌株。结论　大肠埃希菌，表皮葡萄球菌和近平滑念珠菌是该院血流感染的主要病原菌，铜绿假单胞菌对常用抗生素耐药率较高，应定期进行血流感染病原菌分布及耐药监测，指导临床合理用药。

Analysis of the distribution and drug resistance of pathogenic bacteria for septicemia at a hospital between 2008 and 2014

Abstract: Objective The objective of the study was to investigate the distribution and drug resistance of pathogenic bacteria for septicemia in the last seven years, so as to provide relevant information for clinical pratices. Methods Blood specimens of patients were cultured by an automatic blood culture system, and positive specimens were subjected to bacterial identification and drug sensitivity test. The results were compiled and statistically analyzed by WHONET. Results The pathogenic bacteria for septicemia isolated from our hospital in the last seven years were mainly gram-negative bacteria (47.07%), followed by gram-positive bacteria (36.36%) and fungi (16.60%). 68.77% of the patients with septicemia were from the ICU. Escherichia coli, Staphylococcus epidermidis, and Candida parapsilosis were the main pathogens, with the isolation rates being 13.44%, 10.47%, and 9.29%, respectively. The isolation rates of E. coli and Klebsiella pneumoniae had increased over the last seven years, whereas that of C. parapsilosis decreased during the same period. Among the gram-negative bacteria, Pseudomonas aeruginosa was shown to be highly resistant against common antibiotics, and up to 100% resistant against ampicillin and other six types of antibiotics; E. coli and K. pneumoniae were highly sensitive to imipenem and piperacillin/tazobactam. Among the gram-positive bacteria, the isolation rates of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus epidermidis (MRSE) were 54.17% and 77.36%, respectively; the two strains of Staphylococcus were most resistant against penicillin, and least resistant against macrodantin, rifampicin, and quinupristin/dalfopristin (<20%). No strain was resistant against vancomycin and linezolid. Conclusion E. coli, S. epidermidis, and C. parapsilosis remain the main pathogens for septicemia at our hospital, and P. aeruginosa is highly resistant against common antibiotics. Regular monitoring of the distribution and drug resistance of pathogenic bacteria for septicemia should be conducted to provide guidance for rational drug use in clinical practices.