血流感染575例病原菌分布及耐药性分析

目的 探讨近年来血流感染的病原菌分布及其对抗菌药物的耐药状况.方法 选择2004年1月-2008年11月在我院住院的575例血流感染患者,对患者的细菌鉴定及药敏试验结果进行回顾性分析.结果 从575例血流感染患者中共分离出645株病原菌,其中革兰阴性菌338株(占52.4%)、革兰阳性菌267株(占41.4%)、真菌40株(占6.2%),52例患者发生混合感染.分离的病原菌中,主要为凝固酶阴性葡萄球菌(27.6%)、大肠埃希菌(21.7%)、肺炎克雷伯菌(12.6%)、葡萄糖非发酵菌(9.9%)、肠球菌属(3.9%).产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌、肺炎克雷伯菌检出率分别为46.4%和19.7%;耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为54.8%和89.3%.在葡萄糖非发酵菌中,鲍曼不动杆菌、铜绿假单胞菌和洋葱伯克霍尔德菌对多数抗菌药物的耐药率较高;未发现对万古霉素耐药的革兰阳性球菌.结论 导致血流感染的病原菌以革兰阴性菌为主,且血流感染的病原菌的多重耐药增加,尤其是葡萄糖非发酵菌.开展病原菌耐药性监测,对指导临床合理使用抗菌药物及减少耐药菌的产生有重要意义.

Distribution and Drug Resistance of Pathogenic Bacteria in 575 Cases of Bloodstream Infection

Objective To study the distribution and drug resistance of pathogenic bacteria in patients with bloodstream infection(BSI).Methods Five hundred and seventy-five BSI patients hospitalized from Jan.2004 to Nov.2008 were enrolled to perform a retrospective analysis on bacterial identification and drug sensitive test results.Results A total of 645 strains of pathogenic bacteria were isolated,including 338 gram-negative (52.4%),267 gram-positive(41.4%),40 fungi(6.2%).Mixed infection was found in 52 patients.The isolated pathogenic bacteria were mainly coagulase-negative staphylococci(27.6%),Escherichia coli(21.7%),klebsiella pneumoniae(12.6%),glucose non-fermentative bacteria(9.9%),enterococcus(3.9%).The detection rates of Escherichia coli and klebsiella pneumoniae producing superspectrum β-lactamases (ESBLs)were 46.4%,19.7%,respectively;those of methicillin resistant S.aureus(MRSA) and meticillin-resistant coagulase-negative staphylococci(MRCNS) were 54.8%,89.3%,respectively.Glucose non-fermentative bacteria,acinetobacter baumannii,pseudomonas aeruginosa and burkholderia cepacia were highly resistant to most antimicrobials;gram-positive cocci resistant to vancomycin were not found.Conclusion The pathogenic bacteria inducing BSI are mainly gram-negative,and the multiple drug resistance of BSI pathogenic bacteria,especially glucose non-fermentative,is increasing.Monitoring drug resistance of pathogenic bacteria is of importance in guiding clinical rational use of antimicrobial drugs and reducing drug resistance bacteria.