| 摘要: |
| 目的：分析天津市南开医院临床常见的血培养病原菌的分布特征及耐药性变迁，为血流感染的临床治疗用药及院内感染监控提供依据。方法：收集天津市南开医院2015—2017年的血培养资料，采用BecT/Alert3D全自动血培养仪对血培养瓶进行连续监测，Vitek 2 Compact全自动微生物分析系统对血标本中分离的病原菌进行鉴定及药敏，用whonet5.6软件和SPSS 20.0软件对结果进行回顾性分析。结果：血培养共分离病原菌1834株，其中革兰阳性菌732株，占39.91%；革兰阴性菌968株，占52.78%；真菌84株，占4.58%；厌氧菌50株，占2.73%。革兰阳性菌中凝固酶阴性葡萄球菌最多，其次为屎肠球菌、金黄色葡萄球菌和粪肠球菌；革兰阴性菌检出主要为大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌。主要分布在肝胆胰外科、重症医学科和微创外科。2015—2017年人葡萄球菌人亚种和表皮葡萄球菌对喹诺酮类药物的耐药率均有显著上升（P<0.05），金黄色葡萄球菌对四环素的耐药率逐年下降（P<0.01）。大肠埃希菌对哌拉西林、头孢他啶、第一、二、四代头孢菌素、氨苄西林/舒巴坦和氨曲南的耐药率均呈下降趋势（P<0.05）。肺炎克雷伯菌肺炎亚种对哌拉西林和妥布霉素的耐药率有所下降（P<0.05），对左氧氟沙星、哌拉西林/他唑巴坦、头孢替坦和阿米卡星的耐药率有所上升（P<0.05），2016年出现对亚胺培南和美罗培南耐药的菌株。铜绿假单胞菌对亚胺培南、氨曲南和喹诺酮类药物的耐药率有显著下降（P<0.05）。结论：我院血培养病原菌以革兰阴性杆菌为主，大肠埃希对多种抗菌药物耐药性较强，肺炎克雷伯菌对部分抗生素耐药率有显著上升，且两者均出现耐碳青霉烯类抗菌药物的菌株，今后应合理使用抗菌药物，加强血流感染病原菌的监测。 |
| 关键词: 血培养 病原菌 耐药性 |
| DOI：10.3969/j.issn.1007-6948.2019.03.001 |
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| 基金项目: |
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| Distribution Characteristics and Drug Resistance Changes of Clinical Common Blood Culture Pathogens from 2015 to 2017 |
| CHEN Ming-hui, SUN Lan-ju, FANG Jie, et al. |
| Department of Laboratory Science, Tianjin
Nankai Hospital, Tianjin (300100), China |
| Abstract: |
| Objective To investigate the distributional characteristics and drug resistance transition of the common pathogens from clinical blood cultures and provide the guidelines for the clinical treatment of bloodstream infections and monitoring of infections in the hospital. Methods The blood culture samples in Tianjin Nankai Hospital between 2015 and 2017 were collected and cultivated with BacT/Alert 3D automated blood culture system, and the identification of bacteria and susceptibility test were performed by Vitek 2 Compact bacterial automatic analyzer. The results were analyzed based on whonet 5.6 and SPSS 20.0 software. Results A total of 1834 strains of pathogens were isolated from blood. There were 732 strains (39.91%) of Gram-positive bacteria, 968 strains (52.78%) of Gram-negative bacteria, 84 strains (4.58%) of fungi and 50 strains (2.73%) of anaerobic bacteria. Coagulase negative Staphylococcus was the highest in Gram-positive cocci, followed by Enterococcus faecium, Staphylococcus aureus and Enterococcus faecalis. The main species of Gram-negative bacteria were Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. They mainly distributed in hepatobiliary and pancreatic surgery, intensive care unit and minimally invasive surgery. In 2015–2017, the resistance rates of Staphylococcus hominis and Staphylococcus epidermidis to quinolones increased significantly (P<0.05), and the resistance rate of Staphylococcus aureus to tetracycline decreased year by year (P<0.01). The resistance rates of Escherichia coli to piperacillin, ceftazidime, first, second and fourth generation cephalosporins, ampicillin/sulbactam and aztreonam were all decreased (P<0.05). The resistance rate of Klebsiella pneumoniae pneumonia to piperacillin and tobramycin decreased (P<0.05), the resistance rate to levofloxacin, piperacillin/ tazobactam, cefotetan and amikacin increased (P<0.05), and trains resistant to imipenem and meropenem appeared in 2016. The resistance rates of Pseudomonas aeruginosa to imipenem, aztreonam and quinolones were significantly decreased (P<0.05). Conclusion The blood culture pathogens in our hospital are mainly Gram-negative bacilli. Escherichia coli has high resistance to various antibiotics. The resistance rate of Klebsiella pneumoniae to some antibiotics has increased significantly, and both of them have Carbapenem resistance. Antibiotics should be used rationally and we need to strengthen the monitoring of bloodstream infection pathogens.
Key words: Blood culture; pathogenic bacteria; antimicrobial resistance |
| Key words: Blood culture pathogenic bacteria antimicrobial resistance |
