嘉兴地区血流感染病原菌临床分布及耐药特性研究
发布时间：2019-03-19 08:30
【摘要】：目的回顾性分析2013年1月—2015年12月嘉兴医学院附属第二医院血流感染患者病原菌分布特点及耐药特性,为临床合理用药提供理论依据。方法收集2013年1月—2015年12月血培养标本,采用Bac T/Alert 3D全自动血培养仪及BactecFX血培养仪进行血液培养;采用BD-phoenix100全自动微生物鉴定系统和VITEK2-Compact全自动微生物鉴定系统对血培养阳性菌株做菌种鉴定和抗菌药物敏感性试验;按照CLSI(Clinical Laboratory Standard Institute)文件中表型确证实验检测ESBLs(Extended-Spectrumβ-lactamases);应用WHONET5.4软件和SPSS17.0软件进行耐药性统计分析。结果 2013年1月—2015年12月临床各科室送检的血培养标本共10633例,血培养阳性菌株844株,主要分布在ICU病区(28.3%,239/844)、普外科病区(14.5%,122/844)、急诊病区(8.0%,68/844)以及呼吸科病区(7.3%,62/844)。血培养阳性菌株中,革兰阴性菌488株(57.8%)、革兰阳性菌332株(39.3%)、真菌24株(2.9%);革兰阳性菌中,主要是凝固酶阴性葡萄球菌(25.5%)、肠球菌属(4.6%)和金黄色葡萄球菌(4.3%),革兰阴性菌中主要是大肠埃希菌(23.9%)、肺炎克雷伯菌(13.4%)和鲍曼不动杆菌(5.0%);葡萄球菌对青霉素类、红霉素、氟喹诺酮类药物耐药性较高,耐甲氧西林凝固酶阴性葡萄球菌和耐甲氧西林金黄色葡萄球菌分别占66.0%和44.4%,金黄色葡萄球菌对万古霉素和利奈唑胺100%敏感,凝固酶阴性葡萄球菌对万古霉素的耐药率是4.4%。肠球菌属耐药率较高,仅对万古霉素和利奈唑胺敏感性较好;大肠埃希菌中,产ESBLs菌株占50%,对哌拉西林/三唑巴坦和头孢哌酮/舒巴坦的敏感性较好,未检出亚胺培南耐药株;肺炎克雷伯菌产ESBLs菌株占25.7%,对常见药物均表现较好的敏感性,亚胺培南耐药率2.7%;鲍曼不动杆菌存在严重的多重耐药现象,对常用抗菌药物的耐药率都在70%以上(包括亚胺培南)。结论嘉兴地区血流感染病原菌分布广泛,革兰阴性菌主要分布在肝胆外科、泌尿外科等外科病区,革兰阳性菌主要分布在ICU病区;不同病原菌间耐药性差异较大,临床应根据各科室血流感染流行病原菌合理选择经验用药,避免耐药性上升。
[Abstract]:Objective to analyze retrospectively the distribution and drug resistance of pathogenic bacteria in the second affiliated hospital of Jiaxing Medical College from January 2013 to December 2015 in order to provide theoretical basis for rational clinical use of drugs. Methods Blood culture samples were collected from January 2013 to December 2015, and blood culture was carried out by Bac T/Alert 3D automatic blood culture instrument and BactecFX blood culture instrument. The BD-phoenix100 automatic microbial identification system and the VITEK2-Compact automatic microbial identification system were used to identify the bacteria and test the antimicrobial susceptibility of the positive strains in blood culture. ESBLs (Extended-Spectrum 尾-lactamases);) was detected by phenotypic confirmatory test in CLSI (Clinical Laboratory Standard Institute) (Extended-Spectrum 尾-lactamases);). Drug resistance was statistically analyzed by WHONET5.4 software and SPSS17.0 software. Results from January 2013 to December 2015, a total of 10633 blood culture samples were sent to clinical departments. 844 blood culture positive strains were mainly distributed in ICU (28.3%, 239 / 844), general surgery (14.5%, 122 / 844), and the blood culture positive strains were mainly distributed in the disease area (28.3%, 239 / 844) and in the general surgery area (14.5%, 122 / 844). Emergency ward (8.0%, 68 / 844) and respiratory ward (7.3%, 62 / 844). Among the positive strains in blood culture, 488 (57.8%) were Gram-negative, 332 (39.3%) were Gram-positive and 24 (2.9%) were fungi. Among gram-positive bacteria, coagulase-negative staphylococci (25.5%), Enterococcus (4.6%) and Staphylococcus aureus (4.3%), Escherichia coli (23.9%), Gram-negative bacteria (Gram-negative bacteria), Escherichia coli (23.9%), Staphylococcus aureus (4.3%) and Escherichia coli (23.9%). Klebsiella pneumoniae (13.4%) and Acinetobacter baumannii (5.0%); Staphylococcus was resistant to penicillin, erythromycin and fluoroquinolone. Methicillin-resistant coagulase-negative staphylococcus and methicillin-resistant Staphylococcus aureus accounted for 66. 0% and 44. 4%, respectively. Staphylococcus aureus was 100% sensitive to vancomycin and ranizolamine while coagulase negative staphylococcus was 4.4% resistant to vancomycin. The resistance rate of Enterococci to vancomycin and ranizolamine was higher than that of Enterococci. In Escherichia coli, 50% of the strains producing ESBLs were sensitive to piperacillin / triazobactam and cefoperazone / sulbactam, and no imipenem resistant strains were detected. ESBLs-producing strains of Klebsiella pneumoniae accounted for 25.7% and showed good sensitivity to common drugs. Imipenem resistance rate was 2.7%. Acinetobacter baumannii has serious multi-drug resistance, and the resistance rate to commonly used antibiotics is more than 70% (including imipenem). Conclusion Gram-negative bacteria are mainly distributed in hepatobiliary surgery, urology and other surgical areas, and Gram-positive bacteria are mainly distributed in ICU disease area in Jiaxing area. There are great differences in drug resistance among different pathogenic bacteria. In order to avoid the increase of drug resistance, drug use should be reasonably selected according to the epidemiological protozoa of blood flow infection in different departments.
【作者单位】： 嘉兴医学院附属第二医院检验科;
【分类号】：R446.5
[Abstract]:Objective to analyze retrospectively the distribution and drug resistance of pathogenic bacteria in the second affiliated hospital of Jiaxing Medical College from January 2013 to December 2015 in order to provide theoretical basis for rational clinical use of drugs. Methods Blood culture samples were collected from January 2013 to December 2015, and blood culture was carried out by Bac T/Alert 3D automatic blood culture instrument and BactecFX blood culture instrument. The BD-phoenix100 automatic microbial identification system and the VITEK2-Compact automatic microbial identification system were used to identify the bacteria and test the antimicrobial susceptibility of the positive strains in blood culture. ESBLs (Extended-Spectrum 尾-lactamases);) was detected by phenotypic confirmatory test in CLSI (Clinical Laboratory Standard Institute) (Extended-Spectrum 尾-lactamases);). Drug resistance was statistically analyzed by WHONET5.4 software and SPSS17.0 software. Results from January 2013 to December 2015, a total of 10633 blood culture samples were sent to clinical departments. 844 blood culture positive strains were mainly distributed in ICU (28.3%, 239 / 844), general surgery (14.5%, 122 / 844), and the blood culture positive strains were mainly distributed in the disease area (28.3%, 239 / 844) and in the general surgery area (14.5%, 122 / 844). Emergency ward (8.0%, 68 / 844) and respiratory ward (7.3%, 62 / 844). Among the positive strains in blood culture, 488 (57.8%) were Gram-negative, 332 (39.3%) were Gram-positive and 24 (2.9%) were fungi. Among gram-positive bacteria, coagulase-negative staphylococci (25.5%), Enterococcus (4.6%) and Staphylococcus aureus (4.3%), Escherichia coli (23.9%), Gram-negative bacteria (Gram-negative bacteria), Escherichia coli (23.9%), Staphylococcus aureus (4.3%) and Escherichia coli (23.9%). Klebsiella pneumoniae (13.4%) and Acinetobacter baumannii (5.0%); Staphylococcus was resistant to penicillin, erythromycin and fluoroquinolone. Methicillin-resistant coagulase-negative staphylococcus and methicillin-resistant Staphylococcus aureus accounted for 66. 0% and 44. 4%, respectively. Staphylococcus aureus was 100% sensitive to vancomycin and ranizolamine while coagulase negative staphylococcus was 4.4% resistant to vancomycin. The resistance rate of Enterococci to vancomycin and ranizolamine was higher than that of Enterococci. In Escherichia coli, 50% of the strains producing ESBLs were sensitive to piperacillin / triazobactam and cefoperazone / sulbactam, and no imipenem resistant strains were detected. ESBLs-producing strains of Klebsiella pneumoniae accounted for 25.7% and showed good sensitivity to common drugs. Imipenem resistance rate was 2.7%. Acinetobacter baumannii has serious multi-drug resistance, and the resistance rate to commonly used antibiotics is more than 70% (including imipenem). Conclusion Gram-negative bacteria are mainly distributed in hepatobiliary surgery, urology and other surgical areas, and Gram-positive bacteria are mainly distributed in ICU disease area in Jiaxing area. There are great differences in drug resistance among different pathogenic bacteria. In order to avoid the increase of drug resistance, drug use should be reasonably selected according to the epidemiological protozoa of blood flow infection in different departments.
【作者单位】： 嘉兴医学院附属第二医院检验科;
【分类号】：R446.5
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