2014-2017年血培养常见病原菌的菌群分布及其耐药性变迁

摘要

目的 了解我院血培养常见病原菌分布及其耐药性变迁,为血流感染的临床诊治及院内感染的有效监控提供依据.方法 对我院2014-2017年血培养阳性常见病原菌及其耐药特性进行统计分析.结果 4年共分离2188株细菌,革兰阴性菌1158株,占52.93％,革兰阳性菌1030株,占47.07％,革兰阴性菌以大肠埃希菌(440株/20.11％)、肺炎克雷伯菌(237株/10.83％)及铜绿假单胞菌(86株/3.93％)为主,革兰阳性菌中表皮葡萄球菌(228株/10.42％)检出率最高,其次为金黄色葡萄球菌(139/6.35％).2015年发现耐厄他培南和亚胺培南血培养阳性肺炎克雷伯菌,到2017年对两者的平均耐药率分别为3.39％和2.97％(P＜0.05).铜绿假单胞菌2014-2016年对氨曲南(37.50％～5.88％)耐药性逐渐下降,2017年未发现氨曲南耐药菌株(P.＜0.01).结论 我院血培养阳性标本细菌检出以革兰阴性菌为主,大肠埃希菌仍是血流感染的最主要致病菌.大肠埃希菌与肺炎克雷伯菌对碳青霉烯类抗菌药物耐药率增长迅速,临床应加强血流感染病原菌的耐药监测,合理使用抗菌药物.%Objective To investigate the distribution and changes in antimicrobial resistance of the common pathogens from positive blood cultures and provide the basis for the clinical diagnosis and the treatment of bloodstream infections and the monitoring of infections in the hospital.Methods The species and their antimicrobial resistant characteristics of the common pathogens from positive blood cultures in 2014-2017 were analyzed statistically.Results A total of 2,188 strains of pathogens were isolated during the four years.There were 1158 (52.93％) strains of Gram-negative bacteria,1030 (47.07％) strains of Gram-positive bacteria.The main species of Gram-negative bacteria were Escherichia coli (n=440,20.11％),Klebsiella pneumoniae (n=237,10.83％),and Pseudomonas aeruginosa (n=86,3.93％).Staphylococcus epidermidis (n=228,10.42％) were the highest in Gram-positive cocci,followed by Staphylococcus aureus (n=139,6.35％).The strains of Klebsiella pneumonia resistant to ertapenem and imipenem emerged in 2015 and the average resistance rates to both of them were 3.39％ and 2.97％,respectively,by 2017 (P＜0.05).The resistance rate of Pseudomonas aeruginosa to aztreonam gradually decreased during 2014-2016,and there was no detection of aztreonam-resistant strains in 2017 (P＜0.01).Conclusion The Gram-negative bacilli took the major part of the positive blood culture of our hospital.Escherichia coli were the main pathogenic bacteria.The resistance rates ofEscherichia coli and Klebsiella pneumoniae to carbapenems increased rapidly.The clinical should strengthen the drug resistance monitoring of the pathogenic bacteria from bloodstream infection and use antibiotics rationally.