南京市江宁医院2015年~2017年血培养阳性病原菌分布及耐药性分析

目的 研究血培养阳性检出的病原菌分布及耐药情况，指导临床合理用药。方法 采用法国梅里埃公司Bact/Alert 3D全自动血培养仪对我院2015年1月~2017年12月送检的血培养标本进行培养，阳性标本用VITEK 2 Compact全自动细菌鉴定及药敏分析系统进行细菌鉴定和药敏试验，观察病原菌分布及耐药情况。结果 共分离出病原菌459株，检出率为9.57%，其中革兰阴性杆菌246株（53.59%），革兰阳性球菌202株（44.01%），真菌11株（2.40%）；前3位病原菌依次为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌。大肠埃希菌对美罗培南、阿米卡星、厄他培南、亚胺培南均较敏感，耐药率低于3%。肺炎克雷伯菌对美罗培南、阿米卡星、厄他培南、亚胺培南、头孢替坦较敏感，耐药率低于6%。未检出对万古霉素、利奈唑胺、喹努普汀/达福普汀、替加环素耐药的金黄色葡萄球菌。结论 本院血培养的病原菌种类多，以革兰阴性杆菌为主，且耐药情况复杂。应加强对病原菌的鉴定和药敏监测，指导临床合理用药，防止广谱抗生素的滥用，减少耐药菌株的产生。

Analysis of Distribution and Drug Resistance of Blood Culture Positive Pathogens in Jiangning Hospital of Nanjing from 2015 to 2017

Objective To study the distribution and drug resistance of pathogens detected positively in blood culture,and to guide clinical rational drug use.Methods The blood culture specimens from January 2015 to December 2017 were cultured in France by Mérieux Bact/Alert 3D automatic blood culture instrument.VITEK 2 Compact automatic bacteria identification and drug sensitivity analysis were used for positive samples.The system carried out bacterial identification and drug susceptibility test to observe the distribution and drug resistance of pathogens.Results A total of 459 strains of pathogenic bacteria were isolated,with a detection rate of 9.57%,including 246 strains of Gram-negative bacilli(53.59%),202 strains of Gram-positive cocci(44.01%),and 11 strains of fungi (2.40%).The first three pathogens were Escherichia coli,Klebsiella pneumoniae,and Staphylococcus aureus.Escherichia coli is sensitive to meropenem,amikacin,ertapenem,and imipenem,and the drug resistance rate is less than 3%.Klebsiella pneumoniae is sensitive to meropenem,amikacin,ertapenem,imipenem,and cefotetan,and the drug resistance rate is less than 6%.Staphylococcus aureus resistant to vancomycin,linezolid,quinupristin/dalfoptin,and tigecycline was not detected.Conclusion There are many types of pathogens in blood culture in this hospital,mainly Gram-negative bacilli,and the drug resistance is complicated.It is necessary to strengthen the identification and drug sensitivity monitoring of pathogenic bacteria,guide the rational use of drugs,prevent the abuse of broad-spectrum antibiotics,and reduce the production of drug-resistant strains.