摘要
目的：分析某三级妇幼保健院血培养报阳时间、病原菌分布及其耐药性，为临床血流感染（BSI）防控和抗菌药物合理使用提供实验室依据。方法对2013年1月—2015年1月该院门诊及住院患者送检血培养标本进行细菌鉴定和药敏试验，以及耐药性分析。结果各科送检血培养标本共1973份，阳性标本219份，阳性率为11．10％。血培养阳性患者中儿科标本居多，为199例。其中革兰阴性（G－）菌98株（44．34％），革兰阳性（G＋）菌111株（50．23％），真菌12株（5．43％）；以凝固酶阴性葡萄球菌居首位（53株，23．98％），其次是大肠埃希菌（39株，17．65％）、金黄色葡萄球菌（23株，10．41％）、肺炎克雷伯菌（15株，6．79％）、铜绿假单胞菌（13株，5．88％），血培养分离上述菌株平均报阳时间为1～2 d。大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶检出率分别为53．85％和53．33％，G－杆菌对碳青霉烯类药物敏感性较好（76．92％～100％）；金黄色葡萄球菌、凝固酶阴性葡萄球菌中，耐甲氧西林菌株分别占39．13％、64．15％，未发现万古霉素和替考拉宁耐药株；光滑假丝酵母菌对5-氟胞嘧啶的耐药率为14．29％，对两性霉素 B 表现为敏感。结论该院血培养分离病原菌以 G＋菌居多，临床医生根据血培养和药敏试验结果选择合适的抗菌药物，有助于减少耐药菌株产生。
Objective To analyze the positive report time,distribution and antimicrobial resistance of pathogens isolated from blood culture at a hospital,so as to provide laboratory basis for prevention,contro1 ,and rational antimicrobialuse for bloodstream infection.Methods From January 2013 to January 2015,blood culture specimens of outpatients and inpatients were performed bacterial identification and antimicrobial susceptibility testing, antimicrobial resistance was analyzed.Results A total of 1 973 blood culture specimens were sent by clinical depart-ments,219 （11 .10%）of which were isolated pathogens.Most positive blood culture specimens were from depart-ment of paediatrics （n = 199 ）.Isolation rates of gram-negative bacteria,gram-positive bacteria,and fungi were 44.34% （n=98）,50.23% （n=111）,and 5.43% （n=12）respectively;the main pathogens was coagulase-negative staphylococcus （n=53,23.98%）,followed by Escherichia coli （n=39,17.65%）,Staphylococcus aureus （n=23, 10.41 %）,Klebsiella pneumoniae （n =15,6.79%）,and Pseudomonas aeruginosa （n =13,5.88%）,the average positive blood culture report time of top five pathogens was 1 -2 days.The detection rates of extended-spectrumβ-lactamase-producing Escherichia coli and Klebsiella pneumoniae accounted for 53.85% and 53.33% respectively, susceptibility of gram-negative bacilli to carbapenems was relatively high（76.92% - 100%）;methicillin-resistant isolates accounted for 39.13% among Staphylococcus aureus and 64.15% among coagulase-negative staphylococ-cus,vancomycin-resistant and teicoplanin-resistant strains were not found;resistant rate of Candida glabrata to 5-fluorocytosine was 14.29%,but was susceptible to amphotericin B.Conclusion The major pathogens isolated blood culture are gram-positive bacteria,in order to reduce the emergence of drug-resistant strains,clinicians should choose antimicrobial agents according to blood culture results and antimicrobial susceptibility testing results.
出处
《中国感染控制杂志》
CAS
北大核心
2015年第11期735-739,共5页
Chinese Journal of Infection Control
基金
国家自然科学基金青年科学基金(81401232)
南京市医学科技发展资金(QRX11222)
南京医科大学科技发展基金(2012NJMU207
2013NJMU132)
关键词
血培养
报阳时间
病原菌
抗药性
微生物
合理用药
blood culture
positive report time
pathogen
drug resistance,microbial
rational drug use
