血培养常见病原菌分布及耐药性分析

摘要

Objective To investigate the distribution and the drug resistance of pathogens in blood culture in our hospital over the past 5 years. Methods The blood samples were cultivated by using the Bactec 9050 system. Isolated colonies were identified and drag sensitivity was tested by ATB Expression of Bio-Merieux of France, and the extended spectrum β-1actamases of E. colt and t pneumoniae were detected by the method recommended in CLSI. Resuits Gram-positive and Gram-negative bacteria accounted for 48.9％ and 43.8％, respectively, and fungi for 7.3％ in 252 strains isolated fiom blood specimens. The most fiequent Gram-negative bacteria isolated were E. colt of 66 strains, and accounting for 26.2％, Salmonella of 46 strains, and accounting for 18.3％, K. pneumoniae of 34 strains,and accounting for 13.5％. ESBLs-producing E. colt strains and K pneumoniae accounted for 24.2％ and 20.6％, respectively. The most frequent gram-positive pathogenic bacteria isolated were Staphylococcus aureus of 31 strains, and accounting for 12.3％ and coagulase negative Staphylococcus coagulase of 25 strains, and accounting for 9.9％. The MRSA occurrence rate was 9.7 ％ and the occurrence of MRCNS was 80.0％. No Gram-positive cocci strains were resistant to vancomycin. Conclusion The pathogens distribution of blood culture are variable in different area.Gram-negative bacilli is the leading pathogens in our hospital and the infection rate of Salmonella is high, which is significant for the epidemiology. It can instruct doctors to utilize antibiotics more reasonably and also guide to formulate experiential therapeutic regimen.%目的 了解我院5年血培养中分离菌株的分布构成比及耐药情况.方法 血培养标本经BD 9050血培养仪培养,分离所得菌株用法国生物梅里埃ATB Expression细菌鉴定/药敏系统进行鉴定和药敏试验,同时根据美国临床实验室标准化委员会(CLSI/NCCLS)标准,检测大肠埃希菌及肺炎克雷伯菌的超广谱β-内酰胺酶(ESBL).结果 在252株分离菌株中,革兰阴性菌占70.6%,革兰阳性菌占25.8%,念珠菌属占3.6%.革兰阴性菌前3位依次是大肠埃希菌66株(26.2%)、沙门菌属46株(18.3%)和肺炎克雷伯菌34株(13.5%).大肠埃希菌和肺炎克雷伯菌产ESBLs菌株分别占37.9%和20.6%.革兰阳性菌以金黄色葡萄球菌31株(12.3%)为主、其次凝固酶阴性葡萄球菌25株(9.9%),耐甲氧西林金黄色葡萄球菌(MRSA)占9.7%;耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)80.O%,无万古霉素耐药菌株.结论 血培养的病原菌分布也存在地域性差异,本院分离的病原菌以革兰阴性杆菌为主,且沙门菌属感染率较高,具有流行病学的重要意义,可指导临床合理使用抗生素,同时为制定经验治疗方案提供依据.