24141份血培养病原菌的分布及耐药性分析

目的 了解医院2009年1月-2011年12月血培养阳性标本检出的病原菌分布及耐药性,为临床血流感染的诊断、治疗提供依据.方法 采用BacT/Alert 3D全自动血培养仪进行血培养,VITEK-2 Compact全自动微生物分析系统进行鉴定,用K-B纸片法进行体外药敏试验,应用WHONET 5.4软件对结果进行统计分析.结果 从24141份血液标本中培养分离病原菌1289株,检出阳性率为5.3％,革兰阴性菌667株,占51.7％,包括大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌、铜绿假单胞菌等,分别占15.2％、7.4％、6.9％、5.5％,革兰阳性菌447株,占34.7％,包括表皮葡萄球菌、金黄色葡萄球菌、人葡萄球菌、溶血性葡萄球菌等,分别占7.7％、5.6％、3.5％、3.2％,真菌133株,占10.3％,包括白色假丝酵母菌、热带假丝酵母菌,分别占3.2％、2.3％；大肠埃希菌、肺炎克雷伯菌对亚胺培南、阿米卡星高度敏感；铜绿假单胞菌、鲍氏不动杆菌对各类抗菌药物的敏感率普遍较低；革兰阳性球菌对万古霉素、替考拉林和喹奴普汀/达福普汀高度敏感；真菌对伏立康唑、两性霉素B、氟康唑高度敏感.结论 引起血流感染的病原菌的菌种复杂、耐药率高,临床应加强血流感染病原菌耐药性监测,合理使用抗菌药物.

Distribution and antibiotic resistance of pathogenic bacteria isolated from 24 141 blood culture samples

OBJECTIVE To investigate the pathogenic bacteria distribution and antibiotic resistance of the isolates from the blood samples collected from Jan.2009 to Dec.2011.METHODS Blood samples were cultivated by BacT/Alert 3D automated system and pathogenic bacteria were identified by VITEK2-Compact system.Antibiotic susceptibility testings were performed according to K-B method,and corresponding results were analyzed with WHONET 5.4 software.RESULTS Totally 1289 strains were isolated from 24 141 blood samples with the positive rate of 5.3 %;among the bacterial strains,the percentages of the gram-negative bacteria,gram-positive bacteria and fungi were 51.7%(667 strains),34.7%(447 strains) and 10.3%(133 strains),respectively.Escherichia coli(15.2%),Klebsiella pneumoniae(7.4%),Acinetobacter baumannii(6.9%) and Pseudomonas aeruginosa(5.5%) were predominant in the gram-negative bacteria,while Staphylococcus epidermidis(7.7%),S.aureus(56.0%),S.hominis(3.5%),and S.haemolyticus(3.2%) were the predominant gram-positive bacteria,and Candida albicans(3.2%) and C.tropicalis(2.3%) were the predominant fungi;the in vitro antibiotic susceptibility testing revealed that amikacin and imipenem also had high susceptibility to E.coli and K.pneumoniae;most antibacterials had low drug susceptibility to P.aeruginosa and A.baumannii;the gram-positive bacteria were highly susceptible to vancomycin,teicoplanin and quinupristin/dalfopristin;voriconazole,amphotericin B and fluconazole were the most powerful antifungal.CONCLUSION The bacterial spectra of the pathogens causing blood stream infections are complex,the drug resistance rates of the species of pathogens are so high that it is necessary to reinforce the monitoring of drug resistance of the pathogens causing blood stream infections and reasonably use antibiotics.