2017-2018年成都市温江区人民医院血流感染病原菌的分布及耐药性分析

目的 了解成都市温江区人民医院血流感染病原菌的分布及耐药性，指导临床合理用药，减少院内感染。方法 回顾性分析2017-2018年成都市温江区人民医院血流感染病原菌的分布及耐药情况。结果 共分离出病原菌229株，其中革兰阴性菌164株，占71.62%，主要为大肠埃希菌、肺炎克雷伯菌；革兰阳性菌59株，占25.76%，主要为金黄色葡萄球菌、凝固酶阴性葡萄球菌；真菌6株，占2.62%。大肠埃希菌对氨苄西林、氨苄西林/舒巴坦、头孢菌素、复方新诺明、喹诺酮类的耐药率均较高，且呈上升趋势；对阿米卡星、米诺环素、呋喃妥因、碳青霉烯类药物的耐药率均较低，且呈下降趋势。肺炎克雷伯菌虽对多数抗菌药物的耐药率低于10%，但对大部分抗菌药物的耐药率呈上升趋势。金黄色葡萄球菌对青霉素的耐药率极高，且呈上升趋势。凝固酶阴性葡萄球菌对大部分抗菌药物的耐药率均较高，但对大环内酯类的耐药率呈下降趋势。葡萄球菌中均未检出耐万古霉素、替考拉宁、利奈唑胺、呋喃妥因、阿米卡星菌株。结论 成都市温江区人民医院血流感染的病原菌主要为革兰阴性菌，对常用抗菌药物表现不同耐药性，临床应建立完善抗菌药物监测体系，合理使用抗菌药物。

Analysis of distribution and drug resistance of bloodstream infection pathogens in Wenjiang District People's Hospital of Chengdu from 2017 to 2018

Objective To study the distribution and drug resistance of bloodstream infection pathogens in Wenjiang District People''s Hospital of Chengdu, to guide the rational use of drugs and to reduce nosocomial infections. Methods The distribution and drug resistance of bloodstream infection pathogens in Wenjiang District People''s Hospital of Chengdu were retrospectivly analyzed. Results A total of 229 strains of pathogenic bacteria were isolated, of which 164 strains were Gram-negative bacilli, with a composition ratio of 71.62%, including Escherichia coli and Klebsiella pneumoniae. There were 59 stains of Gram-positive bacteria with a composition ratio of 25.76%, mainly including Staphylococcus aureus and coagulase negative Staphylococcus. Fungi were 6 strains, accounting for 6.22%. The drug resistance rate of E. coli against ampicillin, ampicillin/sulbactam, cephalosporin, sulfamethoxazole, and quinolones were higher, and had the tendcy of increase. The drug resistance rate of E. coli against amikacin, minocycline, macrodantin, and carbapenems, and had the tendcy of decrease. The drug resistance rate of K. pneumoniae against most antibacterial drugs were lower than 10%, but the drug resistance rate increased year by year. The resistance rate of S. aureus against penicillin was extremely high, and had the tendcy of increase. The resistance rate of coagulase negative Staphylococcus against most antibacterial drugs were higher, and the resistance rate against macrolides had the tendcy of decrease. There was no Staphylococcus resistant to vancomycin, teicoplanin, linezolid, macrodantin or amikacin. Conclusion The pathogens of bloodstream infection in Wenjiang District People''s Hospital of Chengdu are mainly Gram-negative bacteria, which have different resistance to common antibiotics. A perfect antibacterial drug monitoring system should be established to promote rational use of antibiotics.