目的 通过监测内蒙古自治区人民医院2012年1月-2017年12月血流感染病原菌的分布及其耐药性,为临床血流感染合理用药和感染控制提供依据.方法 回顾性分析该院血流感染阳性病原菌株,剔除同一患者相同部位的重复菌株,共2095株.采用Bact/ALERT 3D全自动血培养仪进行血培养,阳性菌进行全自动微生物分析/药敏仪鉴定.采用WHONET5.6软件和SPSS 22.0软件进行数据分析.结果 2095株病原菌中,革兰阴性菌占50.1％,革兰阳性菌占49.9％;凝固酶阴性葡萄球菌(34.8％)、大肠埃希菌(27.8％)、肺炎克雷伯菌(9.1％)、金黄色葡萄球菌(6.9％)、肠球菌属(6.6％)等最为常见;主要分布在ICU(22.5％)、普外科(9.3％)等病区.MRCNS与MRSA的检出率分别占各自菌种的82.3％和44.8％,尚未发现对万古霉素、利奈唑胺耐药的葡萄球菌,屎肠球菌对多种常见抗菌药物的耐药率明显高于粪肠球菌;肠杆菌科细菌大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌对氨苄西林耐药率高(＞80％),但对亚胺培南、美罗培南、阿米卡星和哌拉西林-他唑巴坦等抗菌药物的耐药率≤9.4％;不发酵糖革兰阴性杆菌中鲍曼不动杆菌除对阿米卡星耐药率较低(22.2％)外,对其他抗菌药物耐药率均较高,且表现为多重耐药.结论 血流感染患者病原菌种复杂,革兰阳性菌与革兰阴性菌所占比例持平,病区分布以ICU为主.药敏结果显示检出菌株耐药性强且广谱耐药,故应加强监测病原菌的分布及其耐药性,指导临床合理用药.%Objective The distribution of pathogenic bacteria and antibiotic resistance was studied in the People's Hospital of Inner Mongolia Autonomous Region from January 2012 to December 2017 for rational antimicrobial therapy and control of bloodstream infections. Methods A retrospective analysis was conducted on the pathogenic strains of bloodstream infection. A total of 2 095 strains were collected and subjected to identification by Bact/ALERT 3D automatic blood culture instrument and VITEK 32 automatic microbiological analysis and susceptibility testing. The data were analyzed by using WHONET 5.6 software and SPSS 22.0 software. Results Of the 2 095 strains of pathogens, gram negative bacteria accounted for 50.1％ and gram-positive bacteriaaccounted for 49.9％. Specifically, the top species included coagulase negative Staphylococcus (34.8％), Escherichia coli (27.8％), Klebsiella pneumoniae (9.1％), Staphylococcus aureus (6.9％), and Enterococcus (6.6％). These strains were mainly identified from ICU (22.5％) and general surgery department (9.3％). The prevalence of methicillin-resistant coagulase negative Staphylococcus (MRCNS) and methicillin-resistant Staphylococcus aureus (MRSA) was 82.3％ and 44.8％, respectively. No gram-positive bacteria were resistant to vancomycin and linezolid. The E. faecium strains showed higher resistance rates to common antimicrobial agents than E. faecalis strains. Enterobacteriaceae species including E. coli, K. pneumoniae, and E. cloacae were highly resistant to ampicillin (＞80％). The resistance rate of Enterobacteriaceae species to imipenem, meropenem, amikacin, and piperacillin-tazobactam was lower than 9.4％. In the non-fermentative bacteria, Acinetobacter baumannii strains were highly resistant to multiple antimicrobial agents except amikacin (22.2％). Conclusions The pathogenic bacteria of bloodstream infection are complex, consisting of similar proportion of gram-positive bacteria and gram-negative bacteria. The pathogens were mainly found in ICU. Antibiotic-resistant strains identified are highly resistant to multiple antimicrobial agents. Efforts should be made to strengthen antimicrobial resistance surveillance for rational antimicrobial therapy.
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