2013~2014年我院血培养标本中病原菌的分布及耐药性分析

发布时间：2018-04-24 15:54

  本文选题：血培养 + 病原菌　； 参考：《大连医科大学》2015年硕士论文

【摘要】：目的:分析本院2013年1月~2014年12月血培养分离菌的分布及其耐药性,为临床合理应用抗菌药物提供依据。方法:收集本院2013年1月~2014年12月两年内血培养阳性标本共1534份,采用全自动细菌鉴定及药敏分析系统WalkAway96 plus、API检定系统、K-B纸片法、真菌药敏ATB FUNGUS 3试剂盒对1534例血培养阳性标本进行鉴定和药物敏感性试验,药敏试验的结果应用Whonet 5.5软件对进行统计学分析。结果:1.血培养分离菌的分布:血培养共获分离菌1534株,革兰氏阳性球菌681株,占阳性菌的44.39%,以金黄色葡萄球菌及凝固酶阴性葡萄球菌为主,革兰氏阴性杆菌806株,占阳性菌的52.55%,以大肠杆菌、非发酵菌及肺炎克雷伯杆菌为主,真菌27株,占阳性菌的1.76%。2.金黄色葡萄球菌感染在肾内科所占科室比率最高,肠杆菌科细菌在泌尿外科分离率最高,非发酵菌所占科室感染菌比率中急诊科/ICU为首位,肠球菌和链球菌在心内科比例较高。3.血培养分离菌对常用抗生素的敏感性:革兰阳性菌中,葡萄球菌和肠球菌对青霉素、红霉素、复方新诺明等有很高的耐药性,而对万古霉素、利奈唑胺敏感;屎肠球菌对所测试的大多数抗菌药物的耐药性高于粪肠球菌。大肠杆菌对碳青霉烯类抗生素高度敏感;大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶(extended-spectrumβ-lactamases,ESBLs)菌株分别占55.95%和42.5%。铜绿假单胞菌对β-内酰胺酶/酶抑制剂类、头孢吡肟、美洛培南耐药率均≤30.0%。鲍曼不动杆菌对抗菌药物耐药率≤50.0%的有头孢哌酮/舒巴坦及米诺环素。结论:1.血培养最常见的分离菌依次为凝固酶阴性葡萄球菌、大肠埃希菌、鲍曼不动杆菌、肺炎克雷伯杆菌、金黄色葡萄球菌、肠球菌、铜绿假单胞菌。2.葡萄球菌属细菌中未发现对万古霉素和利奈唑胺耐药株,但MRSA及MRCNS检出率高。肠杆菌科细菌中产ESBLs菌株以大肠埃希菌和肺炎克雷伯菌所占比例较高,且对碳青霉烯类抗生素高度敏感。
[Abstract]:Objective: to analyze the distribution and drug resistance of isolated bacteria isolated from blood culture in our hospital from January 2013 to December 2014 in order to provide evidence for rational clinical application of antimicrobial agents. Methods: a total of 1534 positive blood samples were collected from January 2013 to December 2014 in our hospital. The automatic bacterial identification and drug sensitivity analysis system (WalkAway96 plusus API test system) were used to detect the positive blood samples by K-B disk method. The fungal ATB FUNGUS 3 kit was used to identify and test the drug sensitivity of 1534 positive blood samples. The results of the drug sensitivity test were analyzed by Whonet 5. 5 software. The result is 1: 1. The distribution of isolated bacteria in blood culture: 1534 strains of isolated bacteria and 681 strains of Gram-positive cocci, accounting for 44.39% of the positive bacteria, mainly Staphylococcus aureus and coagulase-negative staphylococcus, 806 Gram-negative bacilli. E. coli, non-fermentative bacteria and Klebsiella pneumoniae accounted for the majority, and fungi accounted for 27 strains, accounting for 1.76.1% of the positive bacteria. Staphylococcus aureus infection was the highest in the Department of Renal Medicine, Enterobacteriaceae was the highest in urology, non-fermentative bacteria was the first in emergency department / ICU, Enterococcus and Streptococcus were higher in cardiology. In Gram-positive bacteria, Staphylococcus and Enterococcus had high resistance to penicillin, erythromycin and compound sulfamine, but sensitive to vancomycin and linazolamine. The resistance of Enterococcus faecium to most of the antimicrobial agents tested was higher than that of Enterococcus faecalis. Escherichia coli was highly sensitive to carbapenem antibiotics, and extended-spectrum 尾 -lactamase extended-spectrum 尾 -lactamases ESBLsproduced by Escherichia coli and Klebsiella pneumoniae accounted for 55.95% and 42.5%, respectively. The resistance rates of Pseudomonas aeruginosa to 尾 -lactamases / enzyme inhibitors, cefepime and meropenem were all 鈮，

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