引起血流感染的革兰阴性菌阳性报警时间及流行病学特征分析

发布时间：2018-01-16 21:31

本文关键词：引起血流感染的革兰阴性菌阳性报警时间及流行病学特征分析　出处：《中华医院感染学杂志》2017年11期 　论文类型：期刊论文

【摘要】：目的了解引起血流感染的革兰阴性菌的分布、耐药性及报警时间等特征,利于临床及时开展有效的抗感染治疗。方法采用全自动血培养仪及自动鉴定药敏系统对2012年1月-2016年9月血培养分离的革兰阴性菌进行鉴定及药敏试验,并对阳性报警时间及流行病学特征进行分析。结果 2012年1月-2016年9月共分离出血流感染革兰阴性菌2 488株,以大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌、铜绿假单胞菌为主,分别占39.51%、19.69%、9.65%、8.24%;大肠埃希菌对亚胺培南和美罗培南的敏感率均为99.59%,对环丙沙星、左氧氟沙星的耐药率较高,均60.00%;肺炎克雷伯菌对亚胺培南和美罗培南的耐药率分别为16.53%和13.27%;除磺胺甲VA唑/甲氧苄啶(40.83%)外,鲍氏不动杆菌对其他抗菌药物的敏感率均30.00%;平均阳性报警时间最短的是阴沟肠杆菌(0.59d),其次是大肠埃希菌、产气肠杆菌、鲍氏不动杆菌、肺炎克雷伯菌;在0.5d内阳性报警达到40.00%以上的有大肠埃希菌、阴沟肠杆菌、产气肠杆菌、肺炎克雷伯菌,而非发酵菌中的铜绿假单胞菌、嗜麦芽寡养单胞菌、洋葱伯克霍尔德菌在0.5d内阳性报警不到10.00%;除洋葱伯克霍尔德菌(30.77%)外,在1d内阳性报警均可以达到75%以上;不同菌种在0.5d,1.0d和2.5d内的阳性报警百分率的差别均有统计学意义。结论医院血流感染病原菌分布较广,耐药情况较为严重,临床医师重视血培养的送检,根据药敏结果及时调整抗菌药物的使用,避免抗菌药物滥用,尽量控制耐药菌的流行。
[Abstract]:Objective to investigate the distribution, drug resistance and alarm time of Gram-negative bacteria causing blood flow infection. Methods to identify Gram-negative bacteria isolated from blood culture from January 2012 to September 2016 by using automatic blood culture instrument and automatic identification drug sensitivity system. Sensitivity test. Results from January 2012 to September 2016, a total of 2 488 strains of Gram-negative bacteria were isolated and infected with Escherichia coli. Klebsiella pneumoniae Acinetobacter baumannii Pseudomonas aeruginosa accounted for 39.51% and 9.65% 8.24m respectively. The susceptibility rates of Escherichia coli to imipenem and meropenem were 99.599.The resistance rates of Escherichia coli to ciprofloxacin and levofloxacin were higher than those of imipenem and meropenem. The resistance rates of Klebsiella pneumoniae to imipenem and meropenem were 16.53% and 13.27 respectively. Except sulfamethazol / trimethoprim (40.83), Acinetobacter baumannii was sensitive to other antimicrobial agents. The shortest positive alarm time was Enterobacter cloacae 0.59 d, followed by Escherichia coli, Enterobacter aerogenes, Acinetobacter baumannii and Klebsiella pneumoniae. Escherichia coli, Enterobacter cloacae, Enterobacter aerogenes, Klebsiella pneumoniae, and Pseudomonas aeruginosa, altobacillus maltophilia were found to be more than 40.00% within 0.5 days. The positive alarm was less than 10.00 in 0.5 days. Except Bolkholderia cepacia 30.77), the positive alarm could reach more than 75% in one day. There were significant differences in the positive alarm rates of different strains within 1.0 and 2.5 days after 0.5 d. Conclusion the distribution of pathogenic bacteria in hospital blood flow infection is wider and the drug resistance is more serious. Clinicians pay more attention to blood culture, adjust the use of antimicrobial agents according to the results of drug sensitivity, avoid the abuse of antimicrobial agents, and try to control the prevalence of drug-resistant bacteria.
【作者单位】：解放军总医院微生物科;
【基金】：军队“十二五”基金资助项目(AWS11C001)
【分类号】：R446.5;R515.3
【正文快照】： 血流感染(BSI)是医院感染中的重症疾病之一,起病急,具有很高的发病率和病死率,且发病率逐年升高。目前,全自动监测血培养仪应用越来越广泛,已经替代了过去的半人工、半自动监测,全自动血培养仪的应用在很大程度上提高了阳性率,有效缩短了培养瓶的阳性时间,利于临床医师对血流

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