2014-2015年四川省中医院血培养病原菌分布及耐药性分析

发布时间：2018-08-23 15:45

【摘要】：目的分析四川省中医院血培养阳性病原菌分布及耐药性特点,为临床诊断和制定治疗方案提供依据。方法对本院2014-2015年住院病人共6 271份血标本采用ac T/Alert3D 60/120全自动血培养仪进行培养,阳性者用VITEK-2 Compact细菌分析鉴定和药敏试验系统进行细菌鉴定及药敏实验。结果 2014年和2015年送检血标本分别为2 808份和3 463份,病原菌检出率分别为10.90%和9.88%;革兰阴性菌所占比例分别为61.43%和56.30%,前3位均为大肠埃希菌、肺炎克雷伯菌和鲍曼不动杆菌。大肠埃希菌对氨苄西林的耐药率持续偏高(≥86.0%);肺炎克雷伯菌对阿莫西林/克拉维酸及喹诺酮类的耐药率分别从37.50%、18.75%上升至81.25%、50.00%;鲍曼不动杆菌对头孢曲松和氨曲南的耐药率达100.00%。革兰阳性菌中,以凝固酶阴性葡萄球菌、金黄色葡萄球菌和屎肠球菌为主;表皮葡萄球菌对青霉素和苯唑西林的耐药率达100.00%;金黄色葡萄球菌中,MARSA检出率从22.22%上升到34.78%;表皮葡萄球菌和金黄色葡萄球菌均无呋喃妥因、替加环素、万古霉素和利奈唑胺耐药菌株。结论血流感染病原菌主要为革兰阴性细菌;病原菌对常用抗菌药物均有不同程度的耐药,临床应加强细菌耐药性监测,临床医师应根据不同细菌合理选择抗菌药物并严格遵守抗菌素使用指南。
[Abstract]:Objective To analyze the distribution and drug resistance of blood culture positive pathogens in Sichuan Hospital of Traditional Chinese Medicine, and to provide evidence for clinical diagnosis and treatment. Methods A total of 6 271 blood samples were cultured by AC T/Alert 3D 60/120 automatic blood culture instrument from 2014 to 2015. The positive patients were identified by VITEK-2 Compact bacteria analysis and drug use. Results In 2014 and 2015, 2 808 blood samples and 3 463 blood samples were collected. The detection rates of pathogenic bacteria were 10.90% and 9.88% respectively. Gram-negative bacteria accounted for 61.43% and 56.30% respectively. The first three were Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii. Ampicillin resistance rate continued to be high (> 86.0%); Amoxicillin/clavulanate and quinolones resistance rate of Klebsiella pneumoniae increased from 37.50%, 18.75% to 81.25%, 50.00%; Acinetobacter baumannii resistance to ceftriaxone and aztreonam reached 100.00%. Coagulase-negative staphylococci, Staphylococcus aureus were found in Gram-positive bacteria. Staphylococcus epidermidis was resistant to penicillin and oxacillin. Among Staphylococcus aureus, the detection rate of MARSA increased from 22.22% to 34.78%. Staphylococcus epidermidis and Staphylococcus aureus were resistant to furantoin, tigacycline, vancomycin and linezolid. Conclusion The pathogen of bloodstream infection was found. Gram-negative bacteria are the main bacteria; pathogenic bacteria are resistant to commonly used antibiotics to varying degrees. Clinical surveillance of bacterial resistance should be strengthened. Clinicians should select antibiotics reasonably according to different bacteria and strictly abide by the guidelines for antibiotics use.
【作者单位】：成都中医药大学医学技术学院;四川省中医院检验科;
【分类号】：R446.5

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