本文關(guān)鍵詞：北京朝陽醫(yī)院2008—2013年血培養(yǎng)陽性結(jié)果分析　出處：《中國實用內(nèi)科雜志》2016年S1期 　論文類型：期刊論文

  更多相關(guān)文章： 菌血癥 血培養(yǎng) 季節(jié)性變化 陽性報警時間 細菌耐藥性

【摘要】：目的調(diào)查北京朝陽醫(yī)院收治的門診及住院血培養(yǎng)陽性患者的病原微生物的種類、特征、耐藥性及臨床特點。方法回顧性總結(jié)2008年1月至2013年9月血培養(yǎng)陽性患者的微生物學(xué)數(shù)據(jù),采用WHONET5.6軟件進行耐藥性分析。結(jié)果近6年間共送檢血液標(biāo)本27553套,每套包含需氧厭氧各一瓶,其中門診3762套,病房23791套。共分離培養(yǎng)病原菌2381株,其中革蘭陰性桿菌1164株,革蘭陽性球菌1054株,真菌52株,厭氧菌34株。多次培養(yǎng)是同一種菌的患者僅收集第一次資料。革蘭陰性桿菌引起的血流感染存在季節(jié)性差異,感染易發(fā)生在溫度較高的夏季。多數(shù)革蘭陽性球菌引起的血流感染與季節(jié)變化的關(guān)系不明顯,只有糞腸球菌引起的血流感染在春季和秋季較高,春季比冬季增加了60.7%。多數(shù)革蘭陰性桿菌的陽性報警時間在16 h以內(nèi),一個例外是布魯氏菌的陽性報警時間在48 h以后。多數(shù)的革蘭陽性菌在16 h內(nèi)報警,但與革蘭陰性菌相比報警時間稍推后,凝固酶陰性葡萄球菌的陽性報警時間相對較長。真菌及厭氧菌的陽性報警時間在24 h以后,但產(chǎn)氣莢膜梭菌的報警時間在8 h之內(nèi)。血流感染分離的金黃色葡萄球菌中,MRSA占43.2%,糖肽類藥物仍保持著很好的體外抗菌活性。24.4%銅綠假單胞菌對碳青霉烯類耐藥,52.4%鮑曼不動桿菌對碳青霉烯類耐藥,且呈多重耐藥。腸桿菌科細菌ESBLs的分離率是40%,發(fā)現(xiàn)5株耐碳青霉烯類的腸桿菌科細菌。耐藥菌主要分布在ICU。結(jié)論革蘭陰性桿菌引起的血流感染存在季節(jié)性差異,感染易發(fā)生在溫度較高的夏季。多數(shù)革蘭陰性桿菌、革蘭陽性菌的陽性報警時間在16 h以內(nèi),但革蘭陽性菌報警時間稍推后。耐藥菌主要分布在ICU病房。血培養(yǎng)是最好的工具幫助臨床診斷血流感染,指導(dǎo)抗菌藥物的使用,降低患者的病死率。
[Abstract]:Objective to investigate the species and characteristics of pathogenic microorganisms in outpatients and in-patients with positive blood culture in Beijing Chaoyang Hospital. Methods the microbiological data of patients with positive blood culture from January 2008 to September 2013 were retrospectively summarized. Results A total of 27553 blood samples were collected during the past six years, each containing a bottle of aerobic anaerobes, of which 3 762 were outpatient. 23791 sets of pathogens were isolated and cultured, including 1164 Gram-negative bacilli, 1054 Gram-positive cocci and 52 fungi. 34 strains of anaerobic bacteria. Only the first data were collected in patients with the same bacteria. There was seasonal difference in blood stream infection caused by Gram-negative bacilli. Most of the blood stream infections caused by Gram positive cocci were not related to seasonal changes, only the blood stream infections caused by Enterococcus faecalis were higher in spring and autumn. The positive alarm time of most gram-negative bacilli was within 16 hours. One exception was that the positive alarm time of brucella was after 48 hours. Most Gram-positive bacteria were alerted within 16 hours, but the alarm time was slightly delayed compared with Gram-negative bacteria. The positive alarm time of coagulase negative staphylococcus was longer than that of fungi and anaerobic bacteria after 24 hours. However, the alarm time of Clostridium perfringens was within 8 hours. 43.2% of Staphylococcus aureus isolated from blood stream infection were found to be infected with Clostridium perfringens. Glycopeptide drugs still have a good antibacterial activity in vitro. 24.4% Pseudomonas aeruginosa is resistant to carbapenem. 52.4% Acinetobacter baumannii is resistant to carbapenes. The isolation rate of ESBLs from Enterobacteriaceae was 40%. Five strains of Enterobacteriaceae were found to be resistant to carbapenem. The drug resistant bacteria were mainly distributed in ICU.Conclusion there is a seasonal difference in blood stream infection caused by Gram-negative bacilli. Most Gram-negative bacilli were susceptible to infection in summer with high temperature. The positive alarm time of Gram-positive bacteria was within 16 hours. But the warning time of Gram-positive bacteria was slightly delayed. The drug-resistant bacteria were mainly distributed in the ICU ward. Blood culture was the best tool to help clinical diagnosis of blood flow infection, to guide the use of antimicrobial agents, and to reduce the mortality of patients.
【作者單位】： 首都醫(yī)科大學(xué)附屬北京朝陽醫(yī)院感染和臨床微生物科;
【分類號】：R446.5
【正文快照】： 血流感染是膿毒血癥及感染性休克患者病死率的主要原因[1]。歐洲僅2007年約有23000人因金黃色葡萄球菌及大腸埃希菌菌血癥而死亡[2]。2002—2008年引起血流感染前5位的致病菌是金黃色葡萄球菌、大腸埃希菌、肺炎鏈球菌、糞腸球菌和屎腸球菌[3]。于此同時菌血癥的發(fā)生率也在不

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