临床血培养分离病原菌耐药性分析

目的了解医院血培养阳性标本检出的病原菌构成和耐药情况,为临床血流感染诊疗提供参考。方法采用法国生物梅里埃公司的VITEK2-COMPACT全自动微生物分析仪对菌株进行鉴定和药物敏感性分析,BacT/Alert3D全自动血液培养仪进行血培养,并归纳医院2011年1月至2012年10月697株临床血液检出菌及药敏结果。结果共检出697株病原菌,其中革兰阴性杆菌376株（53.95%）;革兰阳性球菌284株（40.75%）;真菌23株（3.30%）;革兰阳性杆菌14株（2.01%）。产ESBLs大肠埃希菌检出率59.32%,产ESBLs肺炎克雷伯菌检出率26.15%,未检出碳青酶烯耐药肠杆菌科细菌。铜绿假单胞菌对碳青酶烯类、氨基糖苷类、喹诺酮类、头孢他啶和头孢吡肟的耐药率均小于40%,泛耐药铜绿假单胞菌检出率19.44%;鲍氏不动杆菌的耐药性高于铜绿假单胞菌,除阿米卡星和氨苄西林/舒巴坦外,对检测的其余抗菌药物耐药率均大于50%,泛耐药鲍氏不动杆菌检出率48.00%。葡萄球菌和肠球菌对万古霉素、替加环素、利奈唑烷、喹奴普汀/达福普汀高度敏感;真菌对所有抗真菌药物的耐药率均小于10%。结论引起医院患者血流感染的病原菌以革兰阴性杆菌和革兰阳性球菌为主,耐药菌株常见,检出泛耐鲍曼不动杆菌和铜绿假单胞菌,未检出碳青酶烯耐药肠杆菌和万古霉素耐药葡萄球菌和肠球菌。

Antibiotic resistance of pathogenic bacteria isolates from clinical blood culture samples

Objective To explore the pathogenic bacteria distribution and antibiotic resistance of the isolates from the blood samples collected from January 2010to October 2012.Methods Blood samples were cultured by BacT/Alert 3Dautomated system.The pathogenic bacteria identification and antibiotic susceptibility were detected by VITEK2Compact system.The information of pathogenic bacteria and its antibiotic susceptibility from January 2011to October 2012were analyzed.Results Totally 697pathogenic strains were got.Among the strains,the percentages of gram-negative bacillus,gram-positive coccidian,gram-positive bacillus and fungi were 53.93%（376strains）,40.75%（284strains）,2.01%（14strains）,3.30%（23strains）.Escherichia coli and Klebsiella pneumoniae producing extendedβ-lactamases（ESBLs）were 59.32%and 26.15%.Carbapenem resistant enterobacteriaceae were not detected.The resistant rate of Pseudomonas aeruginosa to carbapenem,aminoglycosides,fluoroquinolones,ceftazidime and cefepime were less than 40%.The rate of pan-drug resistant Pseudomonas aeruginosa was 19.44%.The drug resistant rate of Acinetobacter baumanii to all antibiotics we detected except amikacin and ampicillin-sulbactam were over than 50%.The rate of pan-drug resistant Acinetobacter baumanii was 48.00%.Staphylococcus and Enterococcus were highly sensitive to vancomycin,tigecycline,linezolid and quinupristin/dalfpristin.The resistant of fungis to flucytosine,amphotericine B,fluconazole,itraconazole and voriconazole were less than 10%.Conclusion Gram-negative bacteria and gram-positive coccidian were the main pathogenic bacteria in blood stream infection.The rate of pathogenic strains resistant to multi-drug was common.Pan-drug resistant Acinetobacter baumanii and pandrug resistant Pseudomonas aeruginosa were found.Carbapenem resistant enterobacteriaceae and vancomycin resistant staphylococcus and Enterococcus were not emerged.