血培养阳性标本病原菌分布及耐药性分析
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张凤华

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R969.3

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Analysis on distribution and drugresistance of  pathogens in positive blood culture
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    摘要:

    目的了解血培养阳性标本检出的病原菌分布和耐药情况,为临床医生正确选用抗菌药物提供依据。方法对某院2007年1月1日—12月31日临床送检的2 317份血培养标本,采用BACTEC9120全自动血培养仪培养, BioMerieux API系统鉴定菌种,KB纸片扩散法进行药敏试验。数据以WHONET 5.3软件进行统计分析。结果血培养标本培养阳性324份,共223人,分布55个病房,阳性率为13.98%。检出细菌26种,真菌3种,共计病原菌223株。其中,革兰阳性球菌109株(48.88%),革兰阴性杆菌106株(47.53%),假丝酵母菌属8株(3.59%);居前4位的感染病原菌依次为凝固酶阴性葡萄球菌67株、大肠埃希菌41株、肺炎克雷伯菌20株、金黄色葡萄球菌15株。中心重症监护室(ICU)、急诊科病房、血液科病房分离菌所占比率分别为21.97%、14.80%、14.35%。凝固酶阴性葡萄球菌中耐甲氧西林菌株(MRCNS)占73.13%,金黄色葡萄球菌中耐甲氧西林菌株(MRSA)占40.00%,大肠埃希菌和肺炎克雷伯菌的超广谱β内酰胺酶(ESBLs)检出率分别为41.46%、30.00%;MRCNS、MRSA及产ESBLs菌株的耐药率均较高。结论血培养阳性标本检出病原菌种类复杂,耐药率高,临床医生应加强对疑似败血症患者血液中病原菌的检测,以合理选用抗菌药物。

    Abstract:

    ObjectiveTo investigate the distribution  and drugresistance of pathogens in  positive blood culture, so as to provide reference for the rational use of antimicrobial agents. MethodsFrom January 1, 2007 to December 31,2007, a total of 2 317 blood samples were cultured by  BACTEC9120 system, the isolates were identified by API system, drug sensitive tests were performed by KirbyBauer test, the data were analyzed by WHONET5.3 software.ResultsTwo hundred and twentythree patients in 55 clinical wards had 324 positive blood culture, the positive rate was 13.98%. The isolated strains include 26 species of bacteria and 3 species of fungi, there were 223 pathogenic strains in total. Grampositive cocci, gramnegative bacilli and Candida were 109(48.88%) strains, 106(47.53%) and 8(3.59%) respectively; The main  pathogenic bacteria were Coagulasenegative staphylococcus (67 strains), Escherichia coli (41), Klebsiella pneumoniae (20) and Staphylococcus aureus (15). The percentage of isolated bacteria in intensive care unit, emergency department and hematological department was 21.97%, 14.80% and 14.35% respectively. Methicillinresistant Coagulase negative staphylococcus (MRCNS) and methicillinresistant Staphylococcus aureus (MRSA) accounted for 73.13% and 40.00% respectively. The detection rate of extendedspectrum βlactams (ESBLs) of Escherichia coli and Klebsiella pneumoniae was  41.46% and 30.00% respectively; Drugresistant rate of MRCNS, MRSA and ESBLsproducing strains were all high.ConclusionThere are varieties of  pathogens isolated from  blood culture, and the drugresistance of pathogens are high, clinicians should pay attention to the culture  of blood  in patients suspected septicemia, so as  to use antimicrobial agents rationally.

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引用本文

张凤华,王大利.血培养阳性标本病原菌分布及耐药性分析[J]. 中国感染控制杂志,2008,7(6):412-415.
ZHANG Fenghua, WANG DAli. Analysis on distribution and drugresistance of  pathogens in positive blood culture[J]. Chin J Infect Control, 2008,7(6):412-415.

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  • 收稿日期:2008-06-05
  • 最后修改日期:2008-08-22
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  • 在线发布日期: 2008-11-30
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