2015—2017年某三甲医院住院患者血培养病原菌分布及耐药性

目的对某三甲医院住院患者血培养病原菌种类及耐药性进行分析，为临床合理应用抗菌药物提供参考。方法收集某院2015年1月—2017年11月住院患者血培养分离菌株的资料，对其分布特点、耐药情况、阳性报警时间等进行回顾性研究。结果共送检血培养标本7 153份，检出病原菌655株。其中，革兰阴性（G-）杆菌370株（56.49%），革兰阳性（G+）球菌262株（40.00％），真菌23株（3.51%）；居前5位的病原菌分别为大肠埃希菌、凝固酶阴性葡萄球菌（表皮葡萄球菌、溶血葡萄球菌、人葡萄球菌）、肺炎克雷伯菌、金黄色葡萄球菌、铜绿假单胞菌。血培养病原菌阳性平均报阳时间从早到晚依次为肠杆菌科（15.50 h）、葡萄球菌属（18.00 h）、非发酵菌属（20.30 h）、肠球菌属（22.50 h）、链球菌属（24.15 h）、真菌（38.35 h）。血培养病原菌阳性检出率最高的科室为肿瘤血液科（24.89%）。未发现对利奈唑胺、替考拉宁、万古霉素耐药的G+球菌；亚胺培南、美罗培南对大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌保持了很好的抗菌活性，耐药率均<5%；鲍曼不动杆菌对哌拉西林、头孢他啶、头孢吡肟、庆大霉素、复方磺胺甲口恶唑耐药率均>65%。结论该院血流感染住院患者对常用抗菌药物耐药较严重，各临床科室分布也有所不同，临床医生应根据血培养阳性病原菌的药敏结果，规范使用抗菌药物。

Distribution and antimicrobial resistance of pathogens from blood culture of hospitalized patients in a tertiary first class hospital

ObjectiveTo analyze the species and antimicrobial resistance of pathogens from blood culture of hospitalized patients in a tertiary first class hospital, and provide reference for clinical rational antimicrobial use. MethodsData of pathogens isolated from blood culture of patients in a hospital between January 2015 and November 2017 were collected, distribution, antimicrobial resistance characteristics, and positive alarming time were studied retrospectively. ResultsA total of 7 153 blood culture specimens were obtained, 655 strains of pathogens were isolated. 370 strains (56.49%) were gram negative bacilli, 262 (40.00%) were gram positive cocci, and 23(3.51%) were fungi. The top 5 pathogens were Escherichia coli, coagulase negative staphylococcus (Staphylococcus epidermidis, Staphylococcus haemolyticus, Staphylococcus hominis), Klebsiella pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa. The average positive alarming time of blood culture from early to late were Enterobacteriaceae(15.50 h), Staphylococcus spp. (18.00 h), non fermentative bacteria (20.30 h), Enterococcus spp. (22.50 h), Streptococcus spp. (24.15 h), and fungi (38.35 h). Department of hematology oncology（24.89%） had the highest isolation rate of pathogens from blood culture. Gram positive cocci was found not to be resistant to linezolid, teicoplanin, and vancomycin; imipenem and meropenem had good antimicrobial activity against Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii (resistance rates were all<5%); resistance rates of Acinetobacter baumannii to piperacillin, ceftazidine, cefepime, gentamicin, and compound sulfamethoxazole were all >65%. ConclusionAntimicrobial resistance of hospitalized patients with bloodstream infection in this hospital is serious and distribution in various clinical departments is different. Clinicians should standardize the use of antimicrobial agents according to antimicrobial susceptibility testing results of positive pathogens from blood culture.