目的 了解某三甲医院血流感染肠杆菌科细菌临床分布特点及耐药性,为指导临床合理抗感染治疗提供依据.方法 应用BD BACTEC FX-400全自动血液培养系统对临床血标本进行上机培养检测,应用VITEK-2全自动微生物鉴定仪对菌株进行上机鉴定及药敏试验,用WHONET5.6软件整理分析相关数据.结果 2011-2015年某三甲医院血流感染患者共分离出肠杆菌科细菌1 892株,主要分布在危重症监护室、血液内科,分别占15.5％、11.8％;分离的病原菌主要为大肠埃希菌、肺炎克雷伯菌,分别占49.4％、29.1％;大肠埃希菌、肺炎克雷伯菌中,产ESBLs菌株的分离率分别为55.6％、39.7％;肠杆菌科细菌对碳青霉烯类、阿米卡星、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦的耐药率较低,对氨苄西林的耐药率较高;产ESBLs菌株对除碳青霉烯类外抗菌药物的耐药率均高于不产酶菌株.结论 医院血流感染肠杆菌科细菌中,主要病原菌为大肠埃希菌、肺炎克雷伯菌.临床应重视血流感染病原菌的分布特点及耐药性监测,从而合理、正确选择抗菌药物.%Objective To investigate pathogens distribution characteristics and antimicrobials resistance of Enterobacteriaceae causing bloodstream infection,and to provide the basis for clinical rational drug use.Methods The blood culture samples were detected by BD BACTEC FX-400 blood culture system and identified by VITEK-2 automated microbial identification system.The antimicrobials susceptibility data was analyzed by WHONET5.6 software.Results From 2011 to 2015,a total of 1 892 Enterobacteriaceae strains were isolated from clinical positive blood culture specimens.The stains mainly distributed in the Intensive Care Unit and the hematology department,accounting for 15.5％ and 11.8％ respectively.The main pathogens were Escherichia coli and Klebsiella pneumoniae,accounting for 49.4％ and 29.1％ respectively.The ESBLs positive rates of Escherichia coli and Klebsiella pneumoniae were 55.6％ and 39.7％ respectively.Antimicrobials susceptibility testing results showed that Enterobacteriaceae were low resistant to Carbapenems,Amikacin,Piperacillin/ Tazobactam,and Cefoperazone/Sulbactam,but were highly resistant to Ampicillin.The antimicrobials resistant rate (except Carbapenems) of ESBLs positive strains were higher than those of ESBLs negative strains.Conclusions The main pathogens of Enterobacteriaceae causing bloodstream infection were Escherichia coli and Klebsiella pneumoniae.We should pay attention to the pathogens distribution characteristics of bloodstream infection and antimicrobials resistance,and use antimicrobials reasonably.
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