医院血流感染的病原菌分布及抗菌药物的耐药性研究
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摘要
目的:研究医院血流感染的病原菌分布及对常用抗菌药物的耐药性,为临床合理使用抗菌药物提供依据。方法:对31144份临床送检的血标本进行细菌培养、鉴定和药敏试验,应用WHONET 5.6对药敏结果进行统计分析。结果:31144份血培养标本中共分离到1653株病原菌,检出率为5.3%。分离得到的1653株病原菌中:革兰阴性菌检出972株(检出率58.8%);革兰阳性菌检出469株(检出率28.4%);真菌检出212株(检出率12.8%)。产超广谱β-内酰胺酶(ESBLs)大肠埃希菌及肺炎克雷伯菌的检出率分别为53.5%及41.1%,耐甲氧西林金黄色葡萄球菌(MRSA)和凝固酶阴性葡萄球菌(MRCNS)的检出率分别为38.5%及77.2%。革兰阴性菌和革兰阳性菌两者耐药率无显著性差异。大肠埃希菌及肺炎克雷伯菌对碳青霉烯类抗菌药物的耐药率为3.5%~4.9%。未发现耐万古霉素和利奈唑胺葡萄球菌。结论:血流感染病原菌种类多,耐药情况复杂,定期对病原菌分布和耐药情况进行监测,可以指导临床合理使用抗菌药物。
Objective: To study the distribution of pathogenic bacteria in bloodstream infection and their resistance to commonly used antibiotics in our hospital, in order to provide references for clinical rational use of antibiotics. Methods: Bacterial culture, identification and drug susceptibility test were carried out in 31144 clinical samples. The result of susceptibility test was analyzed by WHONET 5.6. Results: A total of 1653 strains of pathogens were isolated from 31144 blood samples, and the detection rate was 5.3%. Among 31144 blood samples, there were 972 gram-negative bacteria(the detection rate: 58.8%), 469 gram-positive bacteria(the detection rate: 28.4%) as well as 212 fungi(the detection rate: 12.8%). The detection rates of extended-spectrum β-lactamases(ESBLs) and Escherichia coli and Klebsiella pneumoniae were 53.5% and 41.1%, respectively. The detection rates of methicillin-resistant Staphylococcus aureus(MRSA) and coagulase negative Staphylococcus aureus(MRCNS) were 38.5% and 77.2%, respectively. No significant difference was found between the gramnegative and gram-positive bacteria. The antibiotic resistance rates of Escherichia coli and Klebsiella pneumoniae carbapenems to Carbapenem antibiotics were 3.5%-4.9%. No vancomycin-resistant and linezolid-resistant staphylococcus was found. Conclusion: There were many kinds of pathogenic bacteria in bloodstream infection, and the drug resistance is complex. Therefore, the distribution of pathogens and drug resistance should be monitored periodically to guide clinical rational use of antibiotics.
Objective: To study the distribution of pathogenic bacteria in bloodstream infection and their resistance to commonly used antibiotics in our hospital, in order to provide references for clinical rational use of antibiotics. Methods: Bacterial culture, identification and drug susceptibility test were carried out in 31144 clinical samples. The result of susceptibility test was analyzed by WHONET 5.6. Results: A total of 1653 strains of pathogens were isolated from 31144 blood samples, and the detection rate was 5.3%. Among 31144 blood samples, there were 972 gram-negative bacteria(the detection rate: 58.8%), 469 gram-positive bacteria(the detection rate: 28.4%) as well as 212 fungi(the detection rate: 12.8%). The detection rates of extended-spectrum β-lactamases(ESBLs) and Escherichia coli and Klebsiella pneumoniae were 53.5% and 41.1%, respectively. The detection rates of methicillin-resistant Staphylococcus aureus(MRSA) and coagulase negative Staphylococcus aureus(MRCNS) were 38.5% and 77.2%, respectively. No significant difference was found between the gramnegative and gram-positive bacteria. The antibiotic resistance rates of Escherichia coli and Klebsiella pneumoniae carbapenems to Carbapenem antibiotics were 3.5%-4.9%. No vancomycin-resistant and linezolid-resistant staphylococcus was found. Conclusion: There were many kinds of pathogenic bacteria in bloodstream infection, and the drug resistance is complex. Therefore, the distribution of pathogens and drug resistance should be monitored periodically to guide clinical rational use of antibiotics.
引文
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[13]邢金芳,贾莉婷,张霞,等.儿童感染耐碳青霉烯酶肠杆菌的耐药表型及耐药基因研究[J].中华医院感染学杂志,2014,24(14):3381-3383.
[14]谢宁,郭斌,蔡燕,等.耐碳青霉烯类肠杆菌科细菌的耐药基因研究[J].中华医院感染学杂志,2015,25(24):5555-5558.
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[2]叶应妩,王毓三,申子瑜.全国临床检验操作过程[M].3版.南京:东南大学出版社,2006:738-741.
[3]翟如波,李云慧,孙跃岭,等.某院连续三年医院血流感染病原菌分布特征及耐药性分析[J].中华实验和临床感染病杂志,2016,10(1):36-40.
[4]周庭银,倪语星.临床微生物检验标准化操作[M].上海:上海科学技术出版社,2009:115-118.
[5]李晓琴,王焱,覃珊.医院获得性血流感染患者病原菌分布及耐药性分析[J].中华医院感染学杂志,2014,24(11):2629-2631.
[6]刘德华,张红娟,杜艳,等.14519例血流感染病原菌构成及耐药分析[J].中国抗生素杂志,2016,41(2):137-143.
[7]李淑华,荣恒漠,郭清莲,等.1878株血培养分离菌的分布及耐药情况[J].武汉大学学报:医学版,2016,37(3):493-501.
[8]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):584-592.
[9]张灿,曾云祥,金晓立,等.成人血流感染病原菌的分布及耐药性分析[J].中国微生态学杂志,2015,27(9):1069-1072.
[10]孙雁鸣,鲁海燕,余丹青,等.血流感染病原菌分布与耐药性分析[J].中华医院感染学杂志,2015,25(15):3419-3421.
[11]Pau CK,Ma FF,Ip M,et al.Characteristics and Outcomes Outcomes of Klebsiella Pneumoniae Bacteraemia in Hong Kong[J].Infect Dis(Lond),2015,47(5):283-288.
[12]岳欣,田文君,王鹏,等.产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌的耐药及TEM与SHV基因型分析[J].中华医院感染学杂志,2016,26(14):3125-3128.
[13]邢金芳,贾莉婷,张霞,等.儿童感染耐碳青霉烯酶肠杆菌的耐药表型及耐药基因研究[J].中华医院感染学杂志,2014,24(14):3381-3383.
[14]谢宁,郭斌,蔡燕,等.耐碳青霉烯类肠杆菌科细菌的耐药基因研究[J].中华医院感染学杂志,2015,25(24):5555-5558.
[15]Naas T,Cuzon G,Villegas MV,et al.Genetic Structures at the Origin of Acquisition of the Beta-lactamase Bla KPC Gene[J].Antimicrob Agents Chemother,2008,52(4):1257-1263.
[16]Chitnis AS,Caruthers PS,Rao AK,et al.Outbreak of Carbapenem-resistant Enterobacteriaceae at a Long-term Acute Care Hospital:Sustained Reductions in Transmission through Active Surveillance and Targeted Interventions[J].Infect Control Hosp Epidemiol,2012,33(10):984-992.