2011-2015年北京阜外心血管病医院血培养分离菌的分布及耐药性分析

发布时间：2018-11-28 14:41

【摘要】：目的分析心血管病医院血培养主要分离菌及其耐药性,指导临床抗感染药物的合理应用。方法对2011-2015年临床送检的血培养标本进行检测,对分离菌株进行菌种鉴定及药敏试验并进行综合分析。结果 24 348份血培养标本共分离得细菌2 017株,检出率8.3%,去除同一患者相同部位重复菌株后为1 009株,其中革兰阳性球菌574株(56.9%),主要为凝固酶阴性葡萄球菌(321株,31.8%)、链球菌(111株,11.0%)、金黄色葡萄球菌(55株,5.5%)、粪肠球菌(40株,4.0%)、屎肠球菌(15株,1.5%);革兰阴性杆菌381株(37.8%),主要为鲍曼不动杆菌(68株,6.7%)、铜绿假单胞菌(61株,6.0%)、大肠埃希菌(58株,5.7%)、肺炎克雷伯菌(43株,4.3%)、嗜麦芽窄食单胞菌(34株,3.4%)、阴沟肠杆菌(33株,3.3%);真菌54株(5.4%),白念珠菌占首位。葡萄球菌对利奈唑胺、万古霉素、替加环素、奎奴普丁-达福普汀敏感;粪肠球菌对利奈唑胺、替加环素、高浓度链霉素及高浓度庆大霉素敏感,对青霉素、氨苄西林、万古霉素敏感率较高,对喹诺酮类抗菌药物敏感性尚可;屎肠球菌耐药性较粪肠球菌强,但未发现对万古霉素、利奈唑胺、替加环素、高浓度链霉素及高浓度庆大霉素耐药的菌株;革兰阴性杆菌对头孢哌酮-舒巴坦、哌拉西林-他唑巴坦、头孢吡肟、阿米卡星敏感,鲍曼不动杆菌、铜绿假单胞菌对碳青霉烯类抗生素敏感性较肺炎克雷伯菌、大肠埃希菌、阴沟肠杆菌稍差。结论北京阜外心血管病医院近5年血培养分离得革兰阳性球菌多于革兰阴性杆菌,分布较稳定,不同类型医院患者情况不同,微生物对药物敏感性也会有差异,临床医师应根据所在医院病原菌分布及耐药性特点合理、规范使用抗菌药物。
[Abstract]:Objective to analyze the main isolated bacteria and their drug resistance in blood culture of cardiovascular hospitals and to guide the rational application of anti-infective drugs. Methods the blood culture samples from 2011 to 2015 were tested, and the isolated strains were identified and drug sensitivity tests were carried out. Results A total of 2 017 strains of bacteria were isolated from 24 348 blood samples, the detection rate was 8.3%. After removing repeat strains from the same site of the same patient, there were 1 009 strains, of which 574 strains (56.9%) were Gram positive cocci. The main strains were coagulase negative Staphylococcus (321 strains, 31.8%), Streptococcus (111 strains, 11.0%), Staphylococcus aureus (55 strains, 5.5%), Enterococcus faecalis (40 strains, 4.0%), Enterococcus faecium (15 strains). (1.5 per cent); There were 381 strains of Gram-negative bacilli (37.8%), mainly Acinetobacter baumannii (68 strains, 6.7%), Pseudomonas aeruginosa (61 strains, 6.0%), Escherichia coli (58 strains, 5.7%), Klebsiella pneumoniae (43 strains). (4. 3%), Stenotrophomonas maltophilia (34, 3.4%), Enterobacter cloacae (33, 3.3%); 54 strains (5.4%) of fungi were Candida albicans. Staphylococcus is sensitive to linazolamine, vancomycin, tegacycline, quinupin-dafoputin; Enterococcus faecalis was sensitive to linazolamine, tegicycline, streptomycin and gentamicin, and was sensitive to penicillin, ampicillin and vancomycin. The drug resistance of Enterococcus faecium was stronger than that of Enterococcus faecalis, but there were no strains resistant to vancomycin, linazolamine, tegicycline, streptomycin and gentamicin at high concentration. Gram-negative bacilli were more sensitive to cefoperazone-sulbactam, piperacillin-tazobactam, cefepime, amikacin, Acinetobacter baumannii and Pseudomonas aeruginosa to carbapenem antibiotics than Klebsiella pneumoniae and Escherichia coli. Enterobacter cloacae is slightly worse. Conclusion Gram-positive cocci isolated from Beijing Fuwei Cardiovascular Disease Hospital in recent 5 years are more stable than Gram-negative bacilli. The patients in different types of hospitals have different conditions, and the sensitivity of microbes to drugs will also be different. Clinicians should standardize the use of antibiotics according to the distribution of pathogens and drug resistance in the hospital.
【作者单位】：中国医学科学院北京协和医学院阜外医院实验诊断中心;
【分类号】：R446.5

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