某综合医院住院患者血培养送检结果分析研究
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摘要
目的分析某综合医院住院患者血培养基本情况及病原菌检出结果,为有针对性采取预防措施、合理应用抗生素提供科学依据。方法对某综合医院2017年血培养结果进行统计分析。标本采集在无菌条件下采集静脉血,成人8～10 mL,儿童3～5 mL。采集后立即注入相应血培养瓶,置血培养仪中进行连续振荡培养和监测。细菌鉴定采用的法国生物梅里埃公司的VITEK-60全自动细菌鉴定分析仪。结果 1年中共送检血培养9 296人次,总送检13 499瓶,日均送检37瓶。病原菌检出较多的科室分别是重症医学科(12.59%)、NICU(10.94%)、儿童病区(10.94%)。阳性血培养标本667瓶中最为常见的细菌是革兰氏阴性菌381株,占血培养总数的57.12%,其中大肠埃希菌检出最多为258株(38.68%)。革兰阳性菌中表皮葡萄球菌、金黄色葡萄球菌检出较多,分别为61株(9.15%)和60株(9.14%)。结论不同科室血标本送检率和病原菌检出率不同,阳性血标本中病原菌分布不同,因此应对高危科室采取合理保护性措施(如较少侵入性操作、保护性隔离、增加机体抵抗力等),加强血培养的送检率,根据阳性血标本中病原菌分布不同结合药敏结果合理应用抗生素。
Objective To analyze the blood culture condition and the pathogen detection results of hospitalized patients in a general hospital, and provide scientific evidence for targeted prevention measures and rational application of antibiotics. Methods The blood culture results of a general hospital in 2017 were statistically analyzed. Specimen collection venous blood was collected under aseptic conditions, 8～10 mL for adults and 3～5 mL for children. After the collection, immediately, the corresponding blood culture flask was injected, and continuous shaking culture and monitoring were performed in the blood culture apparatus. Bacterial identification uses the VITEK-60 automatic bacterial identification analyzer which produced by the French bioMerieux company. Results In the one year, 9 296 persontimes were sent for blood test, and 13 499 bottles were sent for inspection,and 37 bottles were sent everyday. The departments with more pathogens were the Department of critical care medicine(12.59%), NICU(10.94%),and the child ward(10.94%). The most common bacteria in the 667 bottles of positive blood culture specimens were 381 strains of Gram-negative bacteria, accounting for 57.12% of the total blood cultures, of which 258 strains(38.68%) were detected by Escherichia coli. Staphylococcus aureus and Staphylococcus aureus were detected in Gram-positive bacteria, 61(9.15%) and 60(9.14%), respectively. Conclusion The detection rate of blood samples and the detection rate of pathogens in different departments are different. The distribution of pathogens in positive blood samples is different. Therefore, reasonable protective measures should be taken for high-risk departments(such as less invasive operation, protective isolation,increase of body resistance, etc.) To strengthen the rate of blood culture detection, according to the distribution of pathogenic bacteria in the positive blood sample, combined with drug sensitivity results, rational application of antibiotics.
Objective To analyze the blood culture condition and the pathogen detection results of hospitalized patients in a general hospital, and provide scientific evidence for targeted prevention measures and rational application of antibiotics. Methods The blood culture results of a general hospital in 2017 were statistically analyzed. Specimen collection venous blood was collected under aseptic conditions, 8～10 mL for adults and 3～5 mL for children. After the collection, immediately, the corresponding blood culture flask was injected, and continuous shaking culture and monitoring were performed in the blood culture apparatus. Bacterial identification uses the VITEK-60 automatic bacterial identification analyzer which produced by the French bioMerieux company. Results In the one year, 9 296 persontimes were sent for blood test, and 13 499 bottles were sent for inspection,and 37 bottles were sent everyday. The departments with more pathogens were the Department of critical care medicine(12.59%), NICU(10.94%),and the child ward(10.94%). The most common bacteria in the 667 bottles of positive blood culture specimens were 381 strains of Gram-negative bacteria, accounting for 57.12% of the total blood cultures, of which 258 strains(38.68%) were detected by Escherichia coli. Staphylococcus aureus and Staphylococcus aureus were detected in Gram-positive bacteria, 61(9.15%) and 60(9.14%), respectively. Conclusion The detection rate of blood samples and the detection rate of pathogens in different departments are different. The distribution of pathogens in positive blood samples is different. Therefore, reasonable protective measures should be taken for high-risk departments(such as less invasive operation, protective isolation,increase of body resistance, etc.) To strengthen the rate of blood culture detection, according to the distribution of pathogenic bacteria in the positive blood sample, combined with drug sensitivity results, rational application of antibiotics.
引文
[1]舒宏,陈艳华,江宗蔚,等.501株肿瘤患者血流感染的病原菌分布及其耐药性分析[J].中国实验诊断学,2018,22(11):1971-1974.
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[8]高丽钦,王武军,甘龙杰,等.2011-2013年临床血培养病原菌的分布及耐药性变迁[J].中国抗生素杂志,2015,40(7):555-560.
[9]张国扬,吴裕丹,谢双锋,等.2012-2016年血液病患者血流感染病原菌分布及耐药性[J].中国感染控制杂志,2018,17(10):853-859.
[10]陈兴英,楼永良.血培养标本中病原菌的分布特征、耐药性变迁和耐药基因分型[J].中国抗生素杂志,2018,30(7):810-817.
[11]陶黎黎,胡必杰,周春妹,等.3644瓶阳性血培养病原菌分析及双份血培养意义评价[J].中华医院感染学杂志,2015,25(21):258-261.
[12]廖云凤,严立.2013-2016年重庆市血流感染病原菌分布及耐药性分析[J].国际检验医学杂志,2018,39(21):2654-2665.
[13]赵梅,伏慧,贾伟.中国西部地区血流感染病原菌分布及耐药性[J].中国抗生素杂志,2018,43(9):1095-1100.
[14]王运铎,吕鹏,张毅华,等.940株血培养分离菌的临床分布及抗菌药物敏感性分析[J].中国微生态学杂志,2015,27(5):584-587,592.
[15]郭健莲,肖斌龙,刘惠娜,等.血培养报阳时间在鉴别血流感染和采血污染中的应用[J].中国感染控制杂志,2015,14(12):803-806.
[16]李艳,杨崇勤.改进皮肤与瓶盖消毒方法对血培养凝固酶阴性葡萄球菌检出率的影响[J].中国感染控制杂志,2016,15(5):324-326.
[2]Stoller J,Halpin L,Weis M,et al.Epidemiology of severe sepsis:2008-2012[J].J Crit Care,2015,31(1):58-62.
[3]Nguyen DB,Shugart A,Lines C,et al.National Healthcare Safety Network(NHSN)Dialysis Event Surveillance Report for 2014[J].Clin J Am Soc Nephrol,2017,12(7):1139-1146..
[4]林永年,何秀华,苏智军,等.700株血培养阳性菌的分布及耐药分析[J].白求恩医学杂志,2017,15(6):694-697.
[5]凌华志,沈继录,王中新,等.血培养阳性分离菌的分布和耐药性分析[J].中国感染与化疗杂志,2014,14(5):420-424.
[6]Stoller J,Halpin L,Weis M,et al.Epidemiology of severe sepsis:2008-2012[J].J Crit Care,2015,31(1):58-62.
[7]邵卫勇,陈淑丹,许玲敏,等.2010-2014年血培养检出病原菌分布与耐药特征[J].中华医院感染学杂志,2015,25(21):4838-4840,4863.
[8]高丽钦,王武军,甘龙杰,等.2011-2013年临床血培养病原菌的分布及耐药性变迁[J].中国抗生素杂志,2015,40(7):555-560.
[9]张国扬,吴裕丹,谢双锋,等.2012-2016年血液病患者血流感染病原菌分布及耐药性[J].中国感染控制杂志,2018,17(10):853-859.
[10]陈兴英,楼永良.血培养标本中病原菌的分布特征、耐药性变迁和耐药基因分型[J].中国抗生素杂志,2018,30(7):810-817.
[11]陶黎黎,胡必杰,周春妹,等.3644瓶阳性血培养病原菌分析及双份血培养意义评价[J].中华医院感染学杂志,2015,25(21):258-261.
[12]廖云凤,严立.2013-2016年重庆市血流感染病原菌分布及耐药性分析[J].国际检验医学杂志,2018,39(21):2654-2665.
[13]赵梅,伏慧,贾伟.中国西部地区血流感染病原菌分布及耐药性[J].中国抗生素杂志,2018,43(9):1095-1100.
[14]王运铎,吕鹏,张毅华,等.940株血培养分离菌的临床分布及抗菌药物敏感性分析[J].中国微生态学杂志,2015,27(5):584-587,592.
[15]郭健莲,肖斌龙,刘惠娜,等.血培养报阳时间在鉴别血流感染和采血污染中的应用[J].中国感染控制杂志,2015,14(12):803-806.
[16]李艳,杨崇勤.改进皮肤与瓶盖消毒方法对血培养凝固酶阴性葡萄球菌检出率的影响[J].中国感染控制杂志,2016,15(5):324-326.