摘要
目的分析福建省泉州市第一医院2013-2018年血培养分离菌的分布及对抗菌药物的耐药性。方法采用美国BD Phoenix 100全自动细菌鉴定仪、纸片扩散法对临床送检血标本中常见分离菌进行鉴定及药敏试验,使用WHONET5.6软件进行数据统计分析。结果收集6年间血培养分离菌共4354株,其中革兰阳性菌1705株,占39.2%,革兰阴性菌2649株,占60.8%。4354株分离菌中居前5位分别为大肠埃希菌(28.2%)﹑凝固酶阴性葡萄球菌(19.7%)﹑克雷伯菌属(13.5%)、链球菌属(9.3%)和金黄色葡萄球菌(6.0%)。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别占各自菌种的19.8%和74.2%,未检测出对万古霉素和利奈唑胺耐药的菌株。粪肠球菌中检出1株利奈唑胺耐药肠球菌,未发现万古霉素耐药粪肠球菌和屎肠球菌;屎肠球菌对多数测试药物的耐药率明显高于粪肠球菌。非脑膜炎肺炎链球菌儿童株中PSSP、PISP和PRSP的检出率分别为80.0%、13.3%和6.7%,成人分离株PSSP、PISP和PRSP的检出率分别为71.7%、13.2%和15.1%。大肠埃希菌、克雷伯菌属、肠杆菌属对碳青霉烯类药物仍高度敏感,细菌耐药率低,均<7%。不动杆菌属对碳青霉烯类耐药率约55%。结论血培养分离菌以革兰阴性菌为主,大肠埃希菌居第一位,其所占比例在2013-2018年6年间呈上升趋势。不同科室血培养分离菌的分布不同,其中以ICU最多见。临床医师对疑似感染的患者在抗菌药物治疗前应及时正确采集、送检感染部位和血标本,并根据细菌药敏结果,科学合理应用抗菌药物。
Objective The distribution and antibiotic resistance of pathogenic bacteria isolated from blood culture was studied in Quanzhou Frist Hospital from January 2013 to December 2018. Methods BD Phoenix100 automated systems and KirbyBauer method were used to identify clinical isolates and antimicrobial susceptibility testing. WHONET 5.6 software was used for statistical analysis. Results A total of 4 354 clinical isolates were collected from January 2013 to December 2018, of which gram negative organisms accounted for 60.8%(2 649/4 354) and gram positive cocci 39.2%(1 705/4 354). The most frequently isolated microorganisms were Escherichia coli(28.2%), followed by coagulase negative Staphylococcus(19.7%), Klebsiella spp.(13.5%), Streptococcus spp.(9.3%), and Staphylococcus aureus(6.0%). The prevalence of methicillin-resistant strains was 19.8% in S. aureus (MRSA) and 74.2% in coagulase negative Staphylococcus(MRCNS) isolates. No staphylococcal strains were found resistant to vancomycin or linezolid. One strain of linezolidresistant Enterococcus was identified in E. faecalis. No E. faecalis or E. faecium isolates were found resistant to vancomycin. E. faecium strains showed higher resistance rates to common antimicrobial agents than E. faecalis strains. Of the 30 non-meningitis S. pneumoniae strains isolated from children, 80.0%, 13.3 % and 6.7% were PSSP, PISP and PRSP, respectively. Of the 53 strains isolated from adults, 71.7%, 13.2% and 15.1% were PSSP, PISP and PRSP, respectively. E. coli, Klebsiella spp., and Enterobacter spp. isolates were still highly susceptible to carbapenems. Less than 7% of these strains were resistant to carbapenems. About 55% of Acinetobacter strains were resistant to imipenem and meropenem. Conclusions The blood culture isolates in this hospital were mainly gram-negative bacteria. E. coli was the most frequently isolated species with an increasing trend during 2013-2018. The distribution of blood culture isolates varies in different departments. Clinicians should actively and appropriately collect blood samples from patients suspected of infection, and scientifically and rationally use antibiotics according to the results of antimicrobial susceptibility testing.
作者
陈清清
张志珊
郭如意
朱焱
明德松
林玉玲
陈晓婷
苏智军
CHEN Qingqing;ZHANG Zhishan;GUO Ruyi;ZHU Yan;MING Desong;LIN Yuling;CHEN Xiaoting;SU Zhijun(Department of Laboratory Medicine,Quanzhou Frist Hospital,Quanzhou Fujian 362000,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2019年第6期670-676,共7页
Chinese Journal of Infection and Chemotherapy
