某教学医院2014—2018年5年间血培养病原菌分布及耐药性变迁

目的 探讨我院2014—2018年5年间血培养病原菌的分布及耐药性变迁，为临床血流感染的诊治提供依据。方法 使用VITEK2 Compact 细菌鉴定系统和VITEK MS质谱仪器进行细菌鉴定，抗菌药物敏感性试验采用VITEK 2 Compact和K-B法进行检测，采用WHONET 5.6软件进行药敏结果的统计分析。结果 5年间血培养共检出病原菌11398株，其中革兰阴性菌占54.7%，革兰阳性菌占38.6%，真菌占6.7%，前5位分离菌分别是：大肠埃希菌(2517株，22.1%)﹑凝固酶阴性葡萄球菌(1951株，17.1%)﹑肺炎克雷伯菌(1572株，13.8%)﹑金黄色葡萄球菌(698株，6.1%)和屎肠球菌(570株，5.0%)。5年间大肠埃希菌对亚胺培南的耐药率由1.1%上升至5.0%；肺炎克雷伯菌对亚胺培南的耐药率由15.7%上升至56.1%；鲍曼不动杆菌对亚胺培南的耐药率平均高达88.1%；铜绿假单胞菌对亚胺培南的耐药率平均为20.8%，对哌拉西林/三唑巴坦﹑环丙沙星和阿米卡星的耐药率均在10%以下；2014—2018年血培养中耐甲氧西林金黄色葡萄球菌的检出率分别为42.6%﹑50.0%﹑40.4%﹑47.5%和35.1%，平均检出率为42.6%。结论 我院血培养病原菌以革兰阴性菌为主，细菌耐药性呈总体上升的趋势，碳青霉烯类耐药肺炎克雷伯菌的检出率显著升高，给临床用药带来极大挑战。

Distribution and drug resistance of pathogens in blood culture in a teaching hospital from 2014 to 2018

Objective To investigate the distribution and drug resistance of pathogens in blood cultures in our hospital from 2014 to 2018, and provide evidence for clinical diagnosis and treatment of bloodstream infections. Methods The bacteria was identified by VITEK2 Compact and the VITEK MS mass spectrometry instrument. The antimicrobial susceptibility test was carried out by VITEK 2 Compact and the disk diffusion method. The drug susceptibility results were analyzed by WHONET 5.6 software. Results A total of 11398 strains of bacteria were detected in blood cultures during the past five years, of which 54.7% was Gram-negative bacteria, 38.6% was Gram-positive bacteria and 6.7% was fungi. The top five isolates were E.coli (2517 strains, 22.1%), coagulase-negative Staphylococcus (1951 strains, 17.1%), K. pneumoniae (1572 strains, 13.8%), S. aureus (698 strains, 6.1%) and E. faecium (570 strains, 5.0%), respectively. In the past five years, the resistance rate of E. coli to imipenem increased from 1.1% to 5.0%, the resistance rate of K. pneumoniae to imipenem increased from 15.7% to 56.1%, A. baumannii with an average resistance rate of 88.1% to imipenem, the average resistance rate of P. aeruginosa to imipenem was 20.8%, and the resistance rate to piperacillin/tazobactam, ciprofloxacin and amikacin was below 10%. The detection rates of methicillin-resistant S. aureus in blood culture from 2014 to 2018 were 42.6%, 50.0%, 40.4%, 47.5% and 35.1%, respectively, with an average detection rate of 42.6%. Conclusions Gram-negative bacteria were the main pathogens in blood cultures in our hospital. The drug resistance of bacteria showed an overall upward trend, and the detection rate of carbapenem-resistant K. pneumoniae increased significantly, which brought great challenges to clinical drug use.