摘要
目的:探讨本院血流感染患者血培养分离病原菌的分布情况及耐药性,为临床经验性治疗及合理用药提供实验室依据。方法:回顾性分析2018年1月-2019年12月本院血流感染患者血培养分离病原菌菌种鉴定及药敏结果,依据CLSI-2019版标准采用WHONET 5.6软件进行统计分析。结果:送检的3 624份血培养标本共分离出病原菌328株,阳性率为9.1%,剔除同一患者培养重复菌株后为292株,其中革兰阴性菌172株占58.9%,革兰阳性菌114株占39.0%,真菌6株占2.1%。以大肠埃希菌居首为65株(22.3%),其次是金黄色葡萄球菌34株(11.6%)、肺炎克雷伯菌31株(10.6%)、腐生葡萄球菌21株(7.2%)、阴沟肠杆菌16株(5.5%)。检出科室以肝胆外科居首为64株(21.9%),其次是血液内科63株(21.6%)、中西医结合科26株(8.9%)。14.7%的金黄色葡萄球菌检出为耐甲氧西林金黄色葡萄球菌(MRSA),万古霉素、利奈唑胺对阳性菌的耐药率都是0。革兰阴性菌大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、铜绿假单胞菌对氨苄西林的耐药率最高,分别为86.2%、100%、87.5%、100%。碳青霉烯类耐药肺炎克雷伯菌(CR-KPN)检出率为8.3%,碳青霉烯类耐药铜绿假单胞菌(CR-PAE)为15.4%,大肠埃希菌和阴沟肠杆菌没有检出碳青霉烯类药物耐药菌株。大肠埃希菌对喹诺酮类药(环丙沙星和左旋氧氟沙星)的耐药率高达55.4%,未发现对替加环素耐药的肠杆菌科细菌。结论:本院血流感染以革兰阴性杆菌为主,大肠埃希菌和金黄色葡萄球菌是血流感染中的主要病原菌,临床应提高血培养的送检及血流感染的监控,合理选用抗生素。
Objective:To explore the distribution and drug resistance of pathogens which are isolated from blood cultures of patients with bloodstream infection in our hospital,and provide laboratory basis for clinical empirical treatment and rational drug use.Method:Retrospective analysis of the identification and drug susceptibility of pathogens which are isolated from blood culture in patients with bloodstream infection in our hospital from January 2018 to December 2019.Statistical analysis was performed using WHONET 5.6 software according to the 2019 Standards Committee of Clinical Laboratory Standards (CLSI).Result:Totally 328 strains of pathogenic bacteria were isolated from 3 624 blood culture specimens submitted for testing,with a positive rate of 9.1%.After removing duplicate strains from the same patient,there were 292 strains.Among them,172 strains of Gram negative bacteria accounted for 58.9%,114 strains of Gram positive bacteria accounted for 39.0%,and 6 strains of fungi accounted for 2.1%.Isolation rate of Escherichia coli ranked the first (65 strains accounted for 22.3%),followed by Staphylococcus aureus (34 strains accounted for 11.6%),Klebsiella pneumoniae (31 strains accounted for 10.6%),Staphylococcus saprophyticus (21 strains accounted for 7.2%),and Enterobacter cloacae (16 strains accounted for 5.5%).Among the detected departments,hepatobiliary surgery with 64 strains (21.9%) ranked the first,followed by the department of hematology with 63 strains (21.6%),and 26 strains (8.9%) in Integrated TCM and Western Medicine Department.Methicillin-resistant Staphylococcus aureus (MRSA) was detected in 14.7% of Staphylococcus aureus.And no strains resistant to Vancomycin or Linezolid were detected.Among Gram negative bacteria,Escherichia coli,Klebsiella pneumoniae,Enterobacter cloacae,and Pseudomonas aeruginosa were the most resistant to Ampicillin,which were 86.2%,100%,87.5%,and 100%,respectively.The detection rate of Klebsiella pneumoniae resistance to carbapenems was 8.3%,Pseudomonas aeruginosa was 15.4%,and no carbapenem-resistant strains were detected in Escherichia coli and Enterobacter cloacae.The resistance rate of Escherichia coli to cycloacetone drugs such as Ciprofloxacin and Levofloxacin was 55.4%.No Tigecycline resistant Enterobacteriaceae was found.Conclusion:The main bloodstream infections in our hospital are Gram negative bacilli.Escherichia coli and Staphylococcus aureus are the main pathogens in bloodstream infections.Clinical examinations and monitoring of bloodstream infections should be improved,and antibiotics should be selected rationally.
作者
戴蕴
肖群
DAI Yun;XIAO Qun(The 908th Hospital of the Joint Logistics Support Force,PLA,Nanchang 330002,China)
出处
《中国医学创新》
CAS
2020年第31期111-115,共5页
Medical Innovation of China
关键词
血流感染
病原菌
分布特点
耐药性
Bloodstream infection
Pathogen
Distribution characteristics
Drug resistance
