门诊患者血培养病原菌分布及耐药性分析

目的：了解本院门诊患者血培养阳性标本的病原菌分布及耐药情况，为临床合理使用抗菌药物提供依据。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菌株的鉴定和药敏试验，使用Whonet 5.6软件进行耐药率分析。结果：从7 774瓶门诊血培养送检标本中共分离出病原菌1 221株，培养阳性率为15.7%，剔除重复株后阳性菌株为569株。其中革兰阴性菌325株（占57.1%），包括大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌，分别占25.0%、12.8%和3.3%，并检出沙门菌12株、创伤弧菌5株和布鲁氏菌3株；革兰阳性菌237株（占41.7%），包括表皮葡萄球菌、金黄色葡萄球菌和人葡萄球菌等，分别占10.5%、6.2%和5.1%；真菌7株（占1.2%）。病原菌的耐药率相对来说较低，肺炎克雷伯菌的产超广谱β-内酰胺酶（ESBLs）阳性率为11.1%，耐甲氧西林金黄色葡萄球菌的分离率为28.6%，肠杆菌科细菌对碳青霉烯类抗菌药物耐药率小于1.0%，未发现耐万古霉素葡萄球菌。结论：门诊患者血培养的主要病原菌为大肠埃希菌、肺炎克雷伯菌和金黄色葡萄球菌，并且这些细菌对临床常用抗菌药物有较好的敏感性。

Distribution and drug resistance of pathogenic bacteria isolated from blood culture in outpatients

Objective: To investigate distribution and drug resistance of pathogenic bacteria isolated from blood culture in outpatients, to provide reference for the clinical rational use of antibiotics. Methods: Blood samples were cultured by BacT/Alert 3D automated system, the identification of strains and the drug susceptibility testing were performed by VITEK 2 COMPACT system, the data were analyzed with Whonet 5.6 software. Results: Totally 1 221 strains were isolated from 7 774 blood culture specimens in outpatients, with the positive rate of 15.7%, there were 569 positive cultures after the repeated strains were get rid of. Among the bacterial strains ,the percentages of the gram-negative bacteria, gram-positive bacteria and fungi were 57.1% (325 strains), 41.7% (237 strains) and 1.2% (7 strains), respectively. Pathogenic bacteria resistance rate was relatively low, the positive rate of ESBLs in Klebsiella pneumoniae was 11.1%, resistance of methicillin-resistant Staphylococcus aureus isolation rate was 28.6%; separation of Enterobacteriaceae to carbapenem antibacterial drug resistance<1.0%, vancomycin resistant Staphylococcus aureus did not be found. Conclusion: The main pathogens of outpatient blood culture are Staphylococcus aureus, Escherichia coli and Klebsiella pneumoniae, and these bacteria are better sensitivity to commonly used antibiotics in clinical practice.