1368份血培养的病原菌分布及耐药性分析

目的:分析我院近6年来血培养中病原菌的阳性率、种类及常见病原菌的药物敏感情况,为临床治疗提供用药依据。方法:采用BacT/ALERTR○120血培养仪培养,用VITEK-32全自动微生物分析系统对血标本中分离的病原菌进行菌株鉴定和药物敏感试验。结果:从1368份血培养标本中分离出病原菌141株,总阳性率为10.3%,其中革兰阴性细菌83株,占58.9%;革兰阳性细菌46株,占32.6%;真菌12株,占8.5%。革兰阴性细菌中,大肠埃希菌、肺炎克雷伯菌对氨苄西林的耐药率最高,分别为92.7%和92.3%,大肠埃希菌对环丙沙星的耐药率较高。超广谱β-内酰氨酶(ESBLs)的大肠埃希菌和肺克雷伯菌菌株分离率分别为24.4%和23.1%。革兰阳性细菌中,金黄色葡萄球菌、凝固酶阴性葡萄球菌对青霉素耐药率达100%,肠球菌对常用抗生素呈高度耐药,未发现葡萄球菌和肠球菌对万古霉素耐药,但有9.1%的肠球菌对万古霉素中度耐药。结论:目前我院血培养分离的病原菌分布较广,肠杆菌科细菌、葡萄球菌是我院菌血症和(或)败血症的主要病原菌;药敏结果提示病原菌耐药性严重且广谱耐药,及时准确的血培养结果能为临床合理选择抗菌药物提供依据。

Analysis of distribution and drug resistance of pathogens isolated from 1368 blood samples

Objective:To analyze the distribution and drug resistance of pathogens in our hospital and to guide clinical treatment of bacterial infection diseases with antibiotics.Methods:From 2000 to 2005,1368 blood samples were incubated and detected by BacT/ALERT 120 automated blood culture analyzer in our hospital.Bacterial identification and antimicrobial susceptibility test were examined by VITEK-32 automated microbial analyzer system.Results:Total 141 strains were isolated,including 83 stains of G~-(58.9%),46 ones of G~ (32.6%) and 12 ones of Candida spp(8.5%).Among 83 stains of G~-,the resistance rates of E.coli and Kleb.pneumoniae to amppicillin were 92.7% and 92.3%,respectively.Drug resistance rate of E.coli to ciprofloxacin was higher than that of other strains.ESBLs positive rate of Kleb.Pneumoniae and E.coli were 23.1% and 24.4%,respectively.Among 46 strains of G~ ,all CNS and Staph.Aureus were resistant to penicillin.Enterococci showed resistance to common antibiotics.All Staphylococci strain showed sensitive to vancomycin.However,9.1% of Enterococci strain showed intermediate resistant to vancomycin.Conclusion:Bacteria isolated from the blood samples in our hospital from 2000 to 2005 distributed widely,and Enterobacteriaceae and Staphylococci were the dominant strains of bacteremia.It was indicated that almost all of strains might be resistant to many antibiotics. Therefore,it is very important to obtain laboratorial antimicrobial susceptibility in time for correct clinical therapy of bacterial infection diseases.