某院5年血流感染病原菌分布及耐药分析
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摘要
目的了解该院血培养病原菌临床分布及耐药性分析,指导临床医生合理使用抗菌药物。方法回顾分析2012-2016年该院门诊及住院患者送检的血培养标本,BACTEC-9120全自动血培养仪培养,VITEK-2及Walk Away40plus进行鉴定及药敏分析,参照CLSI当年标准WHONET 5.6软件进行耐药性分析。结果 5年来血流感染共检出859例病原菌,其中革兰阴性菌618株,占71.9%,革兰阳性菌241株,占28.1%。革兰阴性杆菌对亚胺培南、厄他培南、阿米卡星、妥布霉素耐药率较低,存在对亚胺培南、厄他培南耐药的大肠埃希菌和肺炎克雷伯菌。鲍曼不动杆菌对除头孢曲松外的头孢菌素类、氨基糖苷类、β-内酰胺类抗菌药物耐药率均大于35%,铜绿假单胞菌对大部分抗菌药物耐药率较低。耐甲氧西林金黄色葡萄球菌(MRSA)对青霉素G、苯唑西林、红霉素耐药率达100%。结论革兰阴性杆菌在该院住院患者血流感染中占主要地位,不同细菌耐药情况各不相同,应合理应用抗菌药物,加强医院感染的控制。
Objective To investigate the distribution and antibiotic resistance of the pathogens isolated from positive blood culture in the hospital,therefore to guide clinical doctors to use the antimicrobial agents reasonably.Methods The blood culture specimens of outpatient and hospitalized patients in the hospital from2012 to 2016 were retrospectively analyzed,the BACTEC-9120 full automatic blood culture apparatus was used for the culture,VITEK-2 and Walk Away40 plus were used for the identification and the drug sensitivity analysis.The drug resistance analysis was carried out according to the standard WHONET 5.6 of CLSI standard.Results A total of 859 isolates were detected.Gram-negative bacteria were 618 strains accounting for 71.9%,Gram-positive bacteria were 241 strains accounting for 28.1%.Gram-negative bacteria showed lower percentage of resistance rate to imipenem,ertapenem,amikacin and tobramycin,and Escherichia coli and Klebsiella pneumoniae resistant to imipenem and eopenem were existed.The average resistant rates of Acinetobacter baumannii to cephalosporins(besides cefatriaxone),aminoglycoside andβ-lactam antibiotics were higher than35%.Pseudomonas aeruginosa had relatively low resistant rates to most of drugs.The drug resistant rates of methicillin-resistant S.aureus(MRSA)to penicillin G,oxacillin,erythromycin were 100%.Conclusion Gramnegative bacteria is a major part of the bloodstream infection of hospitalized patients in the hospital.The resistance situation is quite different among various pathogens.Antibiotics should be applied reasonably and strengthen the control of hospital infection.
Objective To investigate the distribution and antibiotic resistance of the pathogens isolated from positive blood culture in the hospital,therefore to guide clinical doctors to use the antimicrobial agents reasonably.Methods The blood culture specimens of outpatient and hospitalized patients in the hospital from2012 to 2016 were retrospectively analyzed,the BACTEC-9120 full automatic blood culture apparatus was used for the culture,VITEK-2 and Walk Away40 plus were used for the identification and the drug sensitivity analysis.The drug resistance analysis was carried out according to the standard WHONET 5.6 of CLSI standard.Results A total of 859 isolates were detected.Gram-negative bacteria were 618 strains accounting for 71.9%,Gram-positive bacteria were 241 strains accounting for 28.1%.Gram-negative bacteria showed lower percentage of resistance rate to imipenem,ertapenem,amikacin and tobramycin,and Escherichia coli and Klebsiella pneumoniae resistant to imipenem and eopenem were existed.The average resistant rates of Acinetobacter baumannii to cephalosporins(besides cefatriaxone),aminoglycoside andβ-lactam antibiotics were higher than35%.Pseudomonas aeruginosa had relatively low resistant rates to most of drugs.The drug resistant rates of methicillin-resistant S.aureus(MRSA)to penicillin G,oxacillin,erythromycin were 100%.Conclusion Gramnegative bacteria is a major part of the bloodstream infection of hospitalized patients in the hospital.The resistance situation is quite different among various pathogens.Antibiotics should be applied reasonably and strengthen the control of hospital infection.
引文
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[8]张吉生,王英,范学财,等.我院流行鲍曼不动杆菌OXA及AmpC酶基因型分析[J].中华全科医学,2016,14(2):270-272.
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[10]王兴宇,张晶,彭志平.4 238份血培养标本的病原菌分布情况及耐药性研究[J].国际检验医学杂志,2017,38(17):2409-2412.
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[12]敖继红,朱小燕,王四利,等.2 162份血培养标本中的病原菌分布及耐药性分析[J].国际检验医学杂志,2014,35(2):152-153.
[13]徐春晖,林青松,孙福军,等.儿童和成人血液病患者血培养病原菌分布及耐药性分析[J].国际检验医学杂志,2017,38(7):990-992.
[14]李治锋,王珏,刘根焰,等.血培养中鉴别凝固酶阴性葡萄球菌为致病菌回归模型的建立与临床评价[J].检验医学,2017,32(3):189-193.
[15]刘德华,胡大春,卢赞,等.1 829例血培养阳性病原菌构成及耐药分析[J].国际检验医学杂志,2015,36(6):740-742.
[2]吕媛,李耘,薛峰,等.卫生部全国细菌耐药监测网(Mohnarin)2011-2012年度血流感染细菌耐药监测报告[J].中国临床药理学杂志,2014,30(3):278-288.
[3]谭积善,邹自英,朱冰,等.成都某院血培养报阳时间、病原菌分布与耐药性研究[J].检验医学与临床,2017,14(3):437-440.
[4]陈斌泽,张媛媛,薛荣利,等.某三级医院2012-2015年血培养病原菌分布及其耐药性[J].中国感染控制杂志,2016,15(3):164-167.
[5]杨春.耐碳青霉烯类抗菌药物肠杆菌科细菌耐药机制研究[D].长春:吉林大学,2016.
[6]陈利涛,王晶莹,付雅捷.血培养病原菌分布及耐药性分析[J].中华医院感染学杂志,2013,23(14):3521-3523.
[7]陈浩俊,郭静,李从荣.武汉市某医院革兰阴性菌血流感染的病原体分布及耐药性分析[J].现代预防医学,2017,44(6):1128-1131.
[8]张吉生,王英,范学财,等.我院流行鲍曼不动杆菌OXA及AmpC酶基因型分析[J].中华全科医学,2016,14(2):270-272.
[9]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(5):420-424.
[10]王兴宇,张晶,彭志平.4 238份血培养标本的病原菌分布情况及耐药性研究[J].国际检验医学杂志,2017,38(17):2409-2412.
[11]MENDES R E,HOGAN P A,STREIT J M,et al.Update on linezolid in vitro activity through the zyvox annual appraisal of potency and spectrum program,2013[J].Antimicrob Agents Chemother,2015,59(4):2454-2457.
[12]敖继红,朱小燕,王四利,等.2 162份血培养标本中的病原菌分布及耐药性分析[J].国际检验医学杂志,2014,35(2):152-153.
[13]徐春晖,林青松,孙福军,等.儿童和成人血液病患者血培养病原菌分布及耐药性分析[J].国际检验医学杂志,2017,38(7):990-992.
[14]李治锋,王珏,刘根焰,等.血培养中鉴别凝固酶阴性葡萄球菌为致病菌回归模型的建立与临床评价[J].检验医学,2017,32(3):189-193.
[15]刘德华,胡大春,卢赞,等.1 829例血培养阳性病原菌构成及耐药分析[J].国际检验医学杂志,2015,36(6):740-742.