2015-2017年四川省人民医院血培养病原菌分布及耐药性变迁
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摘要
目的分析2015-2017年四川省人民医院血培养病原菌分布及耐药性变迁。方法使用Bact-ALERT 3D全自动血培养仪对标本进行培养,采用VITEK-2 Compact全自动细菌鉴定及药敏系统和纸片法鉴定病原菌对药物的敏感性。结果 2015-2017年该院血培养阳性率为11.67%(1 458/12 498),包括793株革兰阴性菌株占54.39%,561株革兰阳性菌株占38.48%,和104株真菌占7.13%。耐碳青霉烯类抗菌药物的肺炎克雷伯菌增加明显。铜绿假单胞菌对碳青霉烯类抗菌药物耐药率稳定(约25%)。鲍曼不动杆菌对常见抗菌药物的耐药性较高。MRSA和MRCNS的分离率分别为29.27%、85.47%。革兰阳性菌对万古霉素和利奈唑胺保持了较好的敏感性。结论本院2015-2017年血培养分离菌以革兰阴性菌为主,主要革兰阴性菌耐药率有上升趋势。
Objective To analyze the distribution and drug resistance of the pathogens isolated from blood culture in the Sichuan province people's hospital from 2015 to 2017.Methods The specimens of blood and bone barrow were cultured by Bact-ALERT 3 D automated blood culture system.VITEK-2 Compact and MIC test were used to detect the drug sensitivity of bacterial isolates from blood and bone marrow cultures.Results The positive rate of the blood culture was 11.67%(1 458/12 498).1458 strains were isolated for the first time from 2015 to 2017,including 793 strains of gram-negative bacteria(54.39%)and 561 strains of gram-positive bacteria(38.48%).Carbapenem resistant K.pneumoniae increased significantly.The resistance rate of Pseudomonas aeruginosa to carbapenem was relatively stable,approximately 25% for 3 years.The resistance rates of A.baumannii strains to most microbial agents were high.The prevalence of methicillin-resistant strain was 29.27% in S.aureus(MRSA)and 85.47% in CNS(MRCNS).Gram-positive bacteria maintained good sensitivity to vancomycin and linezolid.Conclusion The main pathogen of blood culture is Gram-negative bacteria,and there is an uptrend in the main gram negative bacteria.It is obliged to guide clinical rational drug use.
Objective To analyze the distribution and drug resistance of the pathogens isolated from blood culture in the Sichuan province people's hospital from 2015 to 2017.Methods The specimens of blood and bone barrow were cultured by Bact-ALERT 3 D automated blood culture system.VITEK-2 Compact and MIC test were used to detect the drug sensitivity of bacterial isolates from blood and bone marrow cultures.Results The positive rate of the blood culture was 11.67%(1 458/12 498).1458 strains were isolated for the first time from 2015 to 2017,including 793 strains of gram-negative bacteria(54.39%)and 561 strains of gram-positive bacteria(38.48%).Carbapenem resistant K.pneumoniae increased significantly.The resistance rate of Pseudomonas aeruginosa to carbapenem was relatively stable,approximately 25% for 3 years.The resistance rates of A.baumannii strains to most microbial agents were high.The prevalence of methicillin-resistant strain was 29.27% in S.aureus(MRSA)and 85.47% in CNS(MRCNS).Gram-positive bacteria maintained good sensitivity to vancomycin and linezolid.Conclusion The main pathogen of blood culture is Gram-negative bacteria,and there is an uptrend in the main gram negative bacteria.It is obliged to guide clinical rational drug use.
引文
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[2] Clinical and Laboratory Standards Institute.M47 Principle and procedures for blood cultures:approved guideline[S].Wayne:Clinical and Laboratory Standard Institute,2007.
[3] 朱丽娜,何超,陈知行,等.2013年某三甲医院血培养污染菌的特征分析[J].现代预防医学,2015,42(20):3749-3751.
[4] 赵茂吉,辛力华,向瑶,等.2014-2015年四川省中医院血培养病原菌分布及耐药性分析[J].现代预防医学,2017,44(5):894-897.
[5] 李光辉,朱德妹,汪复,等.2012年中国CHINET血培养临床分离菌的分布及耐药性[J].中国感染与化疗杂志,2014,14(6):474-481.
[6] 魏泽庆,沈萍,陈云波,等.Mohnarin 2011年度报告:血流感染细菌构成及耐药性[J].中华医院感染学杂志,2012,22(24):5497-5502.
[7] 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.
[8] Ge Y,Liu XQ,Xu YC,et al.Blood collection procedures influence contamination rates in blood culture:a prospective study[J].Chinese Medical Journal,2011,124(23):4002-4006.
[9] 赵梅,伏慧,贾伟,等.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):1095-1099.