摘要
目的分析某三甲医院血流感染病原菌质谱鉴定、菌株分布、耐药性及临床特征等特点,供临床诊疗参考。方法收集2019年1—12月安徽医科大学第一附属医院门诊和住院患者血培养送检标本共15043份,血培养阳性菌株采用MALDI-TOF MS质谱法、自动化仪器法或纸片扩散法进行菌种鉴定与药敏试验;通过WHONET 5.6软件结合临床资料进行数据综合分析。结果1315份血培养阳性标本通过质谱鉴定检出非重复菌株673份;革兰阳性菌、革兰阴性菌及真菌分别占52.30%、46.81%与0.89%;凝固酶阴性葡萄球菌、大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、鲍曼不动杆菌、屎肠球菌、粪肠球菌和铜绿假单胞菌是分离率较高的菌种(占84.40%,568/673)。耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球检出率分别为41.90%和67.40%,未检出万古霉素、利奈唑胺革兰阳性耐药株。大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶检出率分别达60.90%和16.70%,不同革兰阴性菌对碳青霉烯类药物耐药性差异较大。重症医学科、感染病科、血液内科和儿科是血培养阳性菌株的主要来源(占54.98%,370/673);血流感染患者男女性别比近3:2,且与年龄基本呈正比。结论血流感染病原菌质谱鉴定优势显著、菌种分布复杂、耐药性呈递增趋势,临床应优化诊疗血流感染性疾病、合理使用抗菌药物。
Objective To analyze the characteristics of mass spectrum identification,strain distribution,drug resistance and clinical features of bloodstream infection pathogens in a tertiary hospital,so as to provide reference for clinical diagnosis and treatment.Methods A total of 15,043 blood culture specimens were collected from outpatients and inpatients of the First Affiliated Hospital of Anhui Medical University from January to December 2019.The blood culture-positive strains were identified by MALDI-TOF mass spectrometry,and drug-susceptibilities were tested by an automatic analyzer or disk diffusion assays.The data were comprehensively analyzed by WHONET 5.6 software combined with clinical data.Results A total of 673 non-repeat strains were detected by mass spectrometry in 1315 blood culture-positive specimens,in which the Gram-positive bacteria,Gram-negative bacteria and fungi accounted for 52.30%,46.81% and 0.89%,respectively.The coagulase-negative Staphylococcus,Escherichia coli,Klebsiella pneumoniae,Staphylococcus aureus,Acinetobacter baumannii,Enterococcus faecium,Enterococcus laecalis and Pseudomonas aeruginosa were the strains with high isolation rates(accounting for 84.40%,568/673).The detection rates of methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative Staphylococci were 41.90% and 67.40%,respectively,and no vancomycin and linezolid-positive strains were detected.The detection rates of extended spectrum β-lactamases in Escherichia coli and Klebsiella pneumoniae were 60.90% and 16.70%,respectively,and the resistance of different Gram-negative bacteria to carbapenems varied greatly.The Departments of Intensive Care Medicine,Infectious Diseases,Hematology and Pediatrics were the main sources of blood culture-positive strains(accounting for 54.98%,370/673).The gender ratio of male to female patients with bloodstream infections was nearly 3:2,and it was basically proportional to age.Conclusion The advantages of mass spectrum identification in bloodstream infection pathogen
作者
夏金星
黄玮
黄颖
汪波
徐元宏
XIA Jinxing;HUANG Wei;HUANG Ying;WANG Bo;XU Yuanhong(Department of Laboratory Medicine,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of Medical Oncology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)
出处
《中国现代医生》
2021年第21期114-119,共6页
China Modern Doctor
基金
国家自然科学基金项目(21604079)
安徽省科技厅重点研究与开发计划项目(201904a07020049)。
关键词
血流感染
血培养
细菌质谱鉴定
细菌分布
耐药性分析
Bloodstream infection
Blood culture
Bacterial mass spectrum identification
Bacterial distribution
Drug resistance analysis
