3031例血流感染病原菌分离情况及耐药性分析

目的研究我院血流感染病原菌的分离情况以及对抗生素的耐药情况,以指导临床合理用药。方法采用BACT/ALERT 3D60全自动血培养仪进行血培养,西门子MicroScan WalkAway 40全自动细菌鉴定仪进行细菌鉴定及药敏试验。结果 2009～2011两年间共送检血培养标本3 031例,基本采用单侧双瓶采血,需氧培养1 531例,厌氧培养1 500例,共分离出病原菌268株,阳性率8.84%。其中G+菌152株,占56.7%;G-菌98株,占36.6%;真菌18株,占6.7%。最常见的分离病原菌是凝固酶阴性葡萄球菌、大肠埃希菌。仪器报警阳性在12 h之内82株,12～24 h之间105株,24 h内共有187株,占78.6%,且12 h内同一株兼性厌氧菌培养比需氧培养阳性报告稍快。结论血流感染是临床上最严重感染,快速准确地培养出病原菌并进行耐药性分析是非常重要的,以便指导临床合理用药。另外,对于凝固酶阴性葡萄球菌(CNS),临床医生应结合病史、症状及其他检查来判断是污染还是真正的病原菌。

Analysis of pathogen separation condition and their resistance to antimicro- bials in 3031 blood culture samples

Objective To investigate the distribution of pathogenic bacteria in blood culture and to observe the drug resis- tance in our hospital to provide the basis for clinical antimicrobial therapy. Methods BACT/ALERT 3D60 automated blood culture system was applied for the blood culture. The microorganism identification and antimicrobial resistance tests were performed with the Siemens MicroScan Walkaway 40 automated bacterial identification system. Results Among 3031 blood culture samples, 268 cases were alarm positive with the positive rate of 8.84%. moreover, 152 strains were Gram-positive bacteria（56.7%）, 98 strains were Gram-negative bacteria（36.6） and 18 strains were fungi （6.7%）. The most common iso- lated pathogen bacteria were coagulase-negative staphylococci and Escherichia coll. In all sample, 82 were alarm positive in 12 h with facultative anaerobic culture positive report is slightly faster than the aerobic cultivation, 105 cases were alarm positive between 12-24 h. Conclusion bloodstream infection is the most serious clinical infections, quickly and accurately cultivate pathogens and drug resistance analysis is very important for clinical therapy. As for coagulase-negative staphylo- cocci（cns）, clinicians should be combined with history, symptoms and other tests to determine whether contamination or the real pathogen.