三亚地区血流感染病原菌分布及常见菌株耐药性分析

摘要

目的：了解三亚地区血流感染病原菌的流行分布和耐药情况，为临床医生合理使用抗菌药物提供科学依据。方法采用上海奥普双相血培养瓶（2011年1~5月）和美国BD BACTEC FX全自动血培养仪（2011年6月至2013年8月）进行血培养，用美国BD Phoenix l00自动细菌鉴定仪和珠海迪尔的DL-96细菌鉴定系统进行生化鉴定和药物敏感性分析。结果血培养阳性率为8.68%，其中革兰氏阴性杆菌占55.32%，革兰氏阳性球菌占40.62%，真菌占2.9%。革兰氏阴性菌排名前三位的是大肠埃希菌、肺炎克雷伯菌、假鼻疽伯克霍尔德菌；革兰氏阳性菌则以金黄色葡萄球菌、表皮葡萄球菌和其他凝固酶阴性葡萄球菌为主。哌拉西林/他唑巴坦、阿米卡星对血流感染的大肠埃希菌和肺炎克雷伯菌敏感率均>90.0%。未发现碳青霉烯类耐药的革兰氏阴性杆菌。MRCNS的检出率明显高于MRSA，尚未发现万古霉素和利奈唑胺耐药的葡萄球菌。结论我院血流感染的病原菌种类较多，临床医生应掌握本地区细菌分布情况和耐药特征，根据药敏结果和患者情况采取有效的治疗方案，这对提高治愈率和控制耐药菌株的泛滥具有十分重要的意义。%Objective To understand the distribution and drug resistance of clinical isolates from the blood culture in Sanya area for the scientific guidance of rational use of antibiotics. Methods Using the United States BD FX automatic blood culture system (June 2011-August 2013) and Shanghai AUPU biphasic blood culture bottle of blood culture (1 may 2011), identification and sensitivity analysis using the United States BD Phoenix l00 automatic bacterial identification instrument and Zhuhai Deere DL-96 identification system. Results It is 8.68%in the positive rate of blood culture including 55.32%for Gram-negative bacteria strains, 40.62%for Gram-positive bacteria strains and 2.9%for Candida strains. The top few Gram-negative bacteria were Escherichia coli, Klebsiella pneumoniae, Whit-more Burke Holder bacteria;The top few Gram-positive bacteria were Staphylococcus aureus, Staphylococcus aureus and coagulase negative Staphylococci. The sensitive rate is over 90.0%for piperacillin/tazobactam and amikacin to pathogens with Escherichia coli and Klebsiella pneumoniae in the bloodstream infection. The detection rate of MRCNS was signifi-cantly higher than that of MRSA. Conclusion They are diverse for pathogens in blood stream infection in Sanya peo-ple's Hospital. It is necessary to grasp the distribution and drug resistance of clinical isolates from the blood culture in lo-cal area, which is critical to improve the cure rate and control the proliferation of drug resistence strains, so that clini-cians should choose antibiotics in line with the drug sensitivity test and the patient's individual situation.