4308份血培养标本的致病菌菌种分布及其耐药性分析

目的了解临床血培养致病菌的菌种分布及其耐药情况,为临床合理应用抗菌药物提供科学的依据。方法血液培养标本用全自动血液培养仪BACTEC-FX BD进行培养,阳性标本用全自动微生物鉴定/药敏仪Phoenix-100 BD进行鉴定,并对标本中分离出来的病原菌的分布及耐药情况进行回顾性分析。结果在4 308份血液标本中分离出病原菌385株,阳性检出率为8.9%。其中革兰氏阳性菌218株,占56.6%;革兰氏阴性菌140株,占36.4%;真菌27株,占7.0%。分离率占前6位者为大肠埃希氏菌72株,占18.7%、表皮葡萄球菌44株,占11.4%、真菌27株,占7.0%、金黄色葡萄菌26株,占6.8%、肺炎克雷伯菌24株,占6.2%、腐生葡萄球菌20株,占5.2%。大肠埃希氏菌的耐药率以亚胺培南、美罗培南最低（0）,表皮葡萄球菌的耐药率以利奈唑胺、呋喃妥因最低（0）,金黄色葡萄的耐药率以呋喃妥因、利奈唑胺最低（0）。结论血液培养主要病原菌为革兰氏阳性球菌,各种条件致病菌呈上升趋势,多数病原菌为多重耐药且比较严重,临床应针对性抗菌治疗,并积极预防和控制院内交叉感染,加强血培养标本采集的规范。

Distribution of pathogens detected from 4 308 blood culture samples and analysis of drug resistance

Objective To study the distribution of common pathogens and drug resistance to common antibiotics in patients with septicemia, and to provide scientific basis for clinically targeted antimicrobial therapy. Methods By using BACTEC-FX BD automatic blood culture system for culturing blood samples, the pathogens identification and resistance test were carried out by automatic microorganism identification instrument （Phoenix-100 BD）, and the distribution and drug resistance of pathogens were studied and analyzed. Results Totally 385 strains of pathogens were isolated from 4 308 blood culture samples, with the positive rate of 8.9%, among which 218 （56.6%） were Gram-positive bacteria, 140 （36.4%） were Gram-negative bacteria, and 27 （7.0%） were fungi. The top six pathogens with isola- tion rate higher than others were Escherichia coli （72 strains, 18.7%）, Staphylococcus epidermidis （44 strains, 11.4%）, Fungi （27 strains, 7.0%）, Staphylococcus auresu （26 strains, 6.8%）, Klebsiella pseudomonas （24 strains, 6.2%）, Staphylococcus saprophyticus （20 strains, 5.2%）. Escherichia coli was found lowest resistant to Imipenem and Meropenem, while Staphylococcus epidermidgs and Staphylococcus auresu was lowest resistant to Linczolid and Nitrofurantoin. Conclusion The main pathogens of septicemia are Gram-positive bacteria, with various conditional pathogenic bacteria on the rise. The majority of pathogens arc multi-drug resistant to antibiotics. Clinical physicians should have persistence to actively prevent and control nosocomial cross-infections.