2015-2018年血流感染病原菌菌群分布及耐药性分析

目的:对我院血培养常见病原菌的菌群分布及耐药性进行分析，为临床血流感染治疗和合理应用抗生素提供依据。方法:对我院2015-2018年血培养阳性标本病原菌菌群分布及耐药性进行统计分析。结果:2015-2018年血培养标本分离细菌2 587株，革兰阴性菌1 243株（48.05%），革兰阳性菌1 123株（43.41%），真菌221株（占8.54%）；主要革兰阴性菌为大肠埃希菌（482株/18.63%）、肺炎克雷伯菌（271株/10.48%）、铜绿假单胞菌（97株/3.75%）；主要革兰阳性菌为凝固酶阴性葡萄球菌（583株/22.54%）、金黄色葡萄球菌（157株/6.07%）等；主要真菌为近平滑念珠菌（106株，4.10%）、白色念珠菌（32株，1.24%）等；4年间大肠埃希菌对头孢西丁的耐药率逐渐下降（P＜0.01），肺炎克雷伯菌对亚胺培南的耐药率从2.00%上升至10.05%（P＜0.05），共检出33株耐碳青霉烯肺炎克雷伯菌。结论:我院血培养标本以革兰阴性菌为主，其中大肠埃希菌检出率最高，同时肺炎克雷伯菌检出率呈逐年增长趋势。临床应根据药敏结果合理应用抗生素，及时调整治疗方案，降低血流感染的死亡率。

Distribution and analysis of antimicrobial resistance of pathogens caused bloodstream infection from 2015 to 2018

Objective: To analyze the distribution and antimicrobial resistance of common pathogens in positive blood cultures and provide reference for clinical treatment of bloodstream infection and use antibiotics rationally. Methods:The distribution and antimicrobial resistance of pathogens in positive blood cultures from 2015 to 2018 were analyzed statistically. Results:2 587 strains of bacteria were isolated from blood cultures from 2015 to 2018, 1 243 strains(48.05%) were Gram-negative bacteria,1 123 strains(43.41%) were Gram-positive bacteria and 221 strains(8.54%) were fungi. The main Gram-negative bacteria were Escherichia coli(n=482,18.63%), Klebsiella pneumoniae(n=271,10.48%), Pseudomonas aeruginosa(n=97，3.75%) and Acinetobacter baumannii(n=55，2.13%).The main Gram-positive bacteria were coagulase-negative Staphylococcus（n=583，22.54%）， Staphylococcus aureus（n =157，6.07%）. The main fungi were Candida parapsilosis（n=106, 4.10%） and Candida albicans（n =32，1.24%）. The resistance rate of Escherichia coli to cefoxitin decreased gradually （P＜0.01）, and that of Klebsiella pneumoniae to imipenem increased from 2.00% to 10.05%(P ＜0.05) in the 4 years and a total of 33 strains of carbapenem resistant Klebsiella pneumoniae（CRKP） were detected. Conclusion:Gram-negative bacteria is the main pathogens from blood culture in our hospital. Escherichia coli are the dominant pathogens, and the isolation rate of Klebsiella pneumoniaew is increasing year by year. Antibiotics should be applied rationally according to the results of drug susceptibility in clinic, and the treatment should be adjusted in time to reduce the mortality rate of bloodstream infection.