北京朝阳医院2008—2013年血培养阳性结果分析

发布时间：2018-01-16 12:07

本文关键词：北京朝阳医院2008—2013年血培养阳性结果分析　出处：《中国实用内科杂志》2016年S1期 　论文类型：期刊论文

【摘要】：目的调查北京朝阳医院收治的门诊及住院血培养阳性患者的病原微生物的种类、特征、耐药性及临床特点。方法回顾性总结2008年1月至2013年9月血培养阳性患者的微生物学数据,采用WHONET5.6软件进行耐药性分析。结果近6年间共送检血液标本27553套,每套包含需氧厌氧各一瓶,其中门诊3762套,病房23791套。共分离培养病原菌2381株,其中革兰阴性杆菌1164株,革兰阳性球菌1054株,真菌52株,厌氧菌34株。多次培养是同一种菌的患者仅收集第一次资料。革兰阴性杆菌引起的血流感染存在季节性差异,感染易发生在温度较高的夏季。多数革兰阳性球菌引起的血流感染与季节变化的关系不明显,只有粪肠球菌引起的血流感染在春季和秋季较高,春季比冬季增加了60.7%。多数革兰阴性杆菌的阳性报警时间在16 h以内,一个例外是布鲁氏菌的阳性报警时间在48 h以后。多数的革兰阳性菌在16 h内报警,但与革兰阴性菌相比报警时间稍推后,凝固酶阴性葡萄球菌的阳性报警时间相对较长。真菌及厌氧菌的阳性报警时间在24 h以后,但产气荚膜梭菌的报警时间在8 h之内。血流感染分离的金黄色葡萄球菌中,MRSA占43.2%,糖肽类药物仍保持着很好的体外抗菌活性。24.4%铜绿假单胞菌对碳青霉烯类耐药,52.4%鲍曼不动杆菌对碳青霉烯类耐药,且呈多重耐药。肠杆菌科细菌ESBLs的分离率是40%,发现5株耐碳青霉烯类的肠杆菌科细菌。耐药菌主要分布在ICU。结论革兰阴性杆菌引起的血流感染存在季节性差异,感染易发生在温度较高的夏季。多数革兰阴性杆菌、革兰阳性菌的阳性报警时间在16 h以内,但革兰阳性菌报警时间稍推后。耐药菌主要分布在ICU病房。血培养是最好的工具帮助临床诊断血流感染,指导抗菌药物的使用,降低患者的病死率。
[Abstract]:Objective to investigate the species and characteristics of pathogenic microorganisms in outpatients and in-patients with positive blood culture in Beijing Chaoyang Hospital. Methods the microbiological data of patients with positive blood culture from January 2008 to September 2013 were retrospectively summarized. Results A total of 27553 blood samples were collected during the past six years, each containing a bottle of aerobic anaerobes, of which 3 762 were outpatient. 23791 sets of pathogens were isolated and cultured, including 1164 Gram-negative bacilli, 1054 Gram-positive cocci and 52 fungi. 34 strains of anaerobic bacteria. Only the first data were collected in patients with the same bacteria. There was seasonal difference in blood stream infection caused by Gram-negative bacilli. Most of the blood stream infections caused by Gram positive cocci were not related to seasonal changes, only the blood stream infections caused by Enterococcus faecalis were higher in spring and autumn. The positive alarm time of most gram-negative bacilli was within 16 hours. One exception was that the positive alarm time of brucella was after 48 hours. Most Gram-positive bacteria were alerted within 16 hours, but the alarm time was slightly delayed compared with Gram-negative bacteria. The positive alarm time of coagulase negative staphylococcus was longer than that of fungi and anaerobic bacteria after 24 hours. However, the alarm time of Clostridium perfringens was within 8 hours. 43.2% of Staphylococcus aureus isolated from blood stream infection were found to be infected with Clostridium perfringens. Glycopeptide drugs still have a good antibacterial activity in vitro. 24.4% Pseudomonas aeruginosa is resistant to carbapenem. 52.4% Acinetobacter baumannii is resistant to carbapenes. The isolation rate of ESBLs from Enterobacteriaceae was 40%. Five strains of Enterobacteriaceae were found to be resistant to carbapenem. The drug resistant bacteria were mainly distributed in ICU.Conclusion there is a seasonal difference in blood stream infection caused by Gram-negative bacilli. Most Gram-negative bacilli were susceptible to infection in summer with high temperature. The positive alarm time of Gram-positive bacteria was within 16 hours. But the warning time of Gram-positive bacteria was slightly delayed. The drug-resistant bacteria were mainly distributed in the ICU ward. Blood culture was the best tool to help clinical diagnosis of blood flow infection, to guide the use of antimicrobial agents, and to reduce the mortality of patients.
【作者单位】：首都医科大学附属北京朝阳医院感染和临床微生物科;
【分类号】：R446.5
【正文快照】： 血流感染是脓毒血症及感染性休克患者病死率的主要原因[1]。欧洲仅2007年约有23000人因金黄色葡萄球菌及大肠埃希菌菌血症而死亡[2]。2002—2008年引起血流感染前5位的致病菌是金黄色葡萄球菌、大肠埃希菌、肺炎链球菌、粪肠球菌和屎肠球菌[3]。于此同时菌血症的发生率也在不

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