某院连续三年医院血流感染病原菌分布特征及耐药性分析

目的回顾性分析本院连续3年血培养阳性检出的病原菌分布特征及抗菌药物耐药情况，为血流感染者的诊断和治疗提供依据。 方法选取2012年1月至2014年12月于本院住院患者无菌抽取的血液标本进行培养，对血培养阳性报警后分离培养的纯培养菌落，采用DL-Medical细菌测定系统进行鉴定及药敏试验。 结果连续3年共分离出首次非重复病原菌381株，检出率为9.6%，其中革兰阴性杆菌占60.4%高于革兰阳性球菌；病原菌依次为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌和凝固酶阴性葡萄球菌；年龄分布主要集中在0～1岁和60～91岁患者；科室分布主要在儿科、ICU、血液净化科和肿瘤科。药敏试验结果显示，大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶（ESBLs）检出率分别为55.2%和33.8%，对头孢西丁、阿米卡星和哌拉西林/他唑巴坦敏感性强，可作为经验用药；葡萄球菌中耐甲氧西林金黄色葡萄球菌（MRSA）检出率为30.0%，耐甲氧西林凝固酶阴性葡萄球菌（MRSCN）检出率为52.5%，对四环素、米诺环素、莫西沙星和利福平敏感性均较强，葡萄球菌对青霉素和大环内酯类抗菌药物耐药率高，万古霉素和利奈唑胺可作为治疗葡萄球菌所致血流感染重症患者的首选用药。 结论血流感染病原菌种类多，且耐药情况复杂，临床医生应提高对血液及导管的送检率，实验室应重视血流感染病原菌及耐药性监测，尽早为临床提供及时准确的药敏试验结果，应根据药敏试验结果合理选择抗菌药物，有效地控制血流感染耐药菌的产生和传播。

The distribution and drug resistance of pathogens causing nosocomia bloodstream infections during three consecutive years in a hospital

ObjectiveTo analyze the distribution and drug resistance of pathogens causing nosocomia bloodstream infections in our hospital for three consecutive years, retrospectively, and to provide a basis for the diagnosis and treatment of bloodstream infections. MethodsBlood samples of inpatient in our hospital from January 2012 to December 2014 were cultured, pathogens were isolated from positive alarm blood culture bottles, pathogens identification and drug susceptibility test were performed by DL-Medical bacterium measurement system. ResultsTotal of 381 strains of pathogens were isolated, the detection rate was 9.6%, Gram-negative bacilli accounted for 60.4% and the detection rate of Gram-negative bacilli was higher than that of Gram-positive cocci. The top four pathogens were Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and coagulase-negative Staphylococci. The age of patients mainly concentrated in the 0-1 and 60-91 years old. Pathogens mainly distributed in departments of pediatrics, ICU, blood purification division and oncology. The detected rates of E. coli and K. pneumoniae producing extended-spectrum β-lactamasaes (ESBLs) were 55.2% and 33.8%. The drug susceptibility of E. coli and K. pneumoniae producing ESBLs to cefoxitin, amikacin, piperacillin/tazobactam were significant and these drugs could be used as experience. The detected rates of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus coagulase negative (MRSCN) were 30.0% and 52.5%. The drug susceptibility of MRSA and MRSCN to tetracycline, minocycline, moxifloxacin and rifampicin were strong, and the drug resistance of MRSA and MRSCN to penicillins and macrolides were high, vancomycin and linezolid could be used as the first choice for the therapy in patients with severe bloodstream infection caused by Staphylococcus. ConclusionsPathogens causing nosocomia bloodstream infections were various and the drug resistance were complex. Clinicians should raise the submission rate of blood and catheter. Laboratories should pay attention to the monitoring of pathogens and drug resistance. Laboratories should provide timely and accurate drug susceptibility results for clinicians. Clinicians should choose antimicrobial agents rationally according for drug susceptibility results, and control the emergence and spread of drug resistant pathogens causing nosocomia bloodstream infections effectively.