摘要
目的了解该院2018年1月至2019年12月血流感染病原菌的分布和耐药性,指导临床合理用药。方法采用全自动血培养仪对临床标本进行病原菌培养。血培养阳性的标本用全自动微生物鉴定仪进行菌种鉴定,采用纸片扩散法和仪器法进行药敏试验,用WHONET 5.6作回顾性分析。结果从3928例血培养标本中共分离出非重复病原菌319株,阳性率为8.1%。其中,革兰阴性菌186株(58.3%),革兰阳性菌123株(38.6%),真菌10株(3.1%)。在检出的病原菌中所占比例排前5位为大肠埃希菌(21.0%)、肺炎克雷伯菌(11.3%)、表皮葡萄球菌(9.4%)、金黄色葡萄球菌(7.8%)和铜绿假单胞菌(6.3%)。真菌检出的类型以白色假丝酵母菌为主。大肠埃希菌和肺炎克雷伯菌对碳青霉烯类抗菌药物、阿米卡星、哌拉西林/他唑巴坦耐药率较低,均<10.0%,对氨苄西林、头孢唑啉耐药率较高,均>60.0%;大肠埃希菌和肺炎克雷伯菌对亚胺培南的耐药率分别为3.0%、5.6%,对美罗培南的耐药率分别为1.5%、5.6%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为10.0%、5.0%,对其他抗菌药物耐药率<30.0%;表皮葡萄球菌和金黄色葡萄球菌对克林霉素、红霉素和青霉素G的耐药率较高,均>65.0%,对莫西沙星、利福平和喹诺酮类比较敏感,对万古霉素和利奈唑胺无耐药。结论该院血培养分离的病原菌种类多样,以革兰阴性杆菌为主,对常用抗菌药物表现出不同的耐药性。临床应重视血培养及药敏试验,根据药敏检测结果,科学合理应用抗菌药物。
Objective To analyze the distribution characteristics and drug resistance of bloodstream infection pathogens in hospital from from Jan.2018 to Dec.2019,so as to provide basis for the selection of antibacterial drugs for bloodstream infection.Methods Blood samples were cultured by automated systems were used for bacteria identification.Antimicrobial susceptibility was tested by using Kirby-Bauer method and BD PhoenixTM 100.WHONET5.6 was used for retrospective analysis.Results The positive rate of non-repeated pathogenic bacteria in blood culture was 8.1%(319/3928),which included 186(58.3%)strains of Gram-negative bacilli,123(38.6%)strains of Gram-positive cocci and 10(3.1%)strains of fungi.The top five pathogens isolated from blood samples were Escherichia coli(21.0%),Klebsiella pneumoniae(11.3%),Staphylococcus epidermidis(9.4%),Staphylococcus aureus(7.8%)and Pseudomonas aeruginosa(6.3%).Candida albicans was the main fungal infection pathogen.Escherichia coli and Klebsiella pneumoniae had lower drug resistance rate against carbapenems,amikacin,piperacillin/tazobactam which was lower than 10.0%.The drug resistance rate of Escherichia coli and Klebsiella pneumoniae against ampicillin,cefazolinand were higher than 60.0%.Resistance rates of Escherichia coli and Klebsiella pneumoniae to imipenem were 3.0% and 5.6%.Resistance rates of Escherichia coli and Klebsiella pneumoniae to meropenem were 1.5% and 5.6%.Resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 10.0% and 5.0%,while the drug resistance rate against other common antibacterial drugs were lower than 30.0%.Staphylococcus aureus and Staphylococcus epidermidis was resistant to clindamycin,erythromycin,penicillin G(resistance rate>65.0%)and sensitive to moxifloxacin,rifampicin and quinolones.No staphylococcal strains were found resistant to vancomycin or linezolid.Conclusion Bacterial species isolated from blood cultures diversified in the hospital from 2018 to 2019 and the pathogens are mainly gram-negative bacteria which have different resistance to common antibiotics.Clinical attention should be paid to blood culture,and scientifically and rationally use antibiotics according to the results of antimicrobial susceptibility testing.
作者
苏爱美
SU Aimei(Clinical laboratory,Laiwu Center Hospital of Xinwen Mining Group,Laiwu,Shandong 271103,China)
出处
《检验医学与临床》
CAS
2020年第22期3270-3274,共5页
Laboratory Medicine and Clinic
关键词
血培养
药敏试验
抗菌药物
blood cultivation
drug sensitivity test
antibiotics
