血流感染病原菌分布和耐药性分析.docVIP

血流感染病原菌的分布及耐药性分析 牛俊杰 翟鹏勇 作者单位：048006 晋城，山西省晋城煤业集团总医院检验科 [摘要] 目的 分析血流感染病原菌的分布及耐药性，为临床医师选择抗菌药物提供参考。方法 收集2011年1月1日-2016年12月31日血培养标本，采用BacT/Alert 3D 120型全自动血培养分析仪进行培养，所有分离菌株采用Vitek2-compact系统进行鉴定及药敏试验。数据分析采用Whonet5.6软件。结果 5,122份血培养标本共检出病原菌874株，阳性率为17.1%。其中革兰阳性球菌596株，占68.2%，革兰阴性杆菌265株，占30.3%，真菌属13株，占 1.5%。革兰阳性菌不同菌种的耐药谱明显不同，耐甲氧西林金黄色葡萄球菌（meticillin-resistant Staphylococcus aureus, MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（meticillin-resistant coagulase-negative staphylococci, MRCNS）的检出率分别为14.3%和80.6%，未发现对万古霉素耐药的菌株；肠球菌属中亦未检出对万古霉素和替考拉宁耐药的菌株，其中屎肠球菌对所测试的抗菌药物的耐药性大多数高于粪肠球菌。大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶（extended-spectrum β-Lactamase, ESBLs）菌株分别占35.7%和 25.5%；发现一株对亚胺培南耐药的肺炎克雷伯菌。铜绿假单胞菌对所测试抗菌药物的耐药率均低于42.9%；鲍曼不动杆菌对头孢哌酮/舒巴坦和阿米卡星的耐药率分别为26.1%和30.8%，对其他抗菌药物的耐药率均大于53.8%。凝固酶阴性葡萄球菌（coagulase-negative staphylococci, CNS）既是血流感染病原菌，也是最常见的污染菌。结论临床医师应严格执行无菌操作，降低血培养污染率。治疗血流感染前，应积极寻找原发病灶和病原菌，做到合理使用抗菌药物，降低患者的死亡率。 [关键词] 血流感染；病原菌；耐药性；产ESBLs菌株； Distribution and drug resistance of pathogens isolated from bloodstream infection Junjie NIU, Pengyong ZHAI Department of Clinical Laboratory, General Hospital of Jincheng Anthracite Mining Group Co,. Ltd, Jincheng 048006, China [Abstract] Objective To analyze the distribution and drug resistance of pathogens isolated from bloodstream infection so as to provide a reference for clinicians to choose antimicrobial agents. Methods The blood culture of patients from January 1st 2011 to December 31st 2016 were collected. Blood cultured by BacT/Alert 3D 120, all isolates identified using Vitek2-compact automated microorganism. Drug susceptibility test was performde by Vitek2-compact. The data were analyzed by WHONET 5.6 software. Results In the total 5,122 blood culture specimens, there are 874 strains (17.1%) of pathogens, including 596 strains (68.2%) of gram-positive bacteria, 265 strains (30.3%) of gram-negaitive bacteria, and 13 strains (1.5%) of fungi. The drug resistant spectrums of gram-positive bacteria were different. The detected rates of the meticillin-resistant Staphyloco