發(fā)布時(shí)間：2019-03-19 08:30

【摘要】：目的回顧性分析2013年1月—2015年12月嘉興醫(yī)學(xué)院附屬第二醫(yī)院血流感染患者病原菌分布特點(diǎn)及耐藥特性,為臨床合理用藥提供理論依據(jù)。方法收集2013年1月—2015年12月血培養(yǎng)標(biāo)本,采用Bac T/Alert 3D全自動(dòng)血培養(yǎng)儀及BactecFX血培養(yǎng)儀進(jìn)行血液培養(yǎng);采用BD-phoenix100全自動(dòng)微生物鑒定系統(tǒng)和VITEK2-Compact全自動(dòng)微生物鑒定系統(tǒng)對(duì)血培養(yǎng)陽性菌株做菌種鑒定和抗菌藥物敏感性試驗(yàn);按照CLSI(Clinical Laboratory Standard Institute)文件中表型確證實(shí)驗(yàn)檢測(cè)ESBLs(Extended-Spectrumβ-lactamases);應(yīng)用WHONET5.4軟件和SPSS17.0軟件進(jìn)行耐藥性統(tǒng)計(jì)分析。結(jié)果 2013年1月—2015年12月臨床各科室送檢的血培養(yǎng)標(biāo)本共10633例,血培養(yǎng)陽性菌株844株,主要分布在ICU病區(qū)(28.3%,239/844)、普外科病區(qū)(14.5%,122/844)、急診病區(qū)(8.0%,68/844)以及呼吸科病區(qū)(7.3%,62/844)。血培養(yǎng)陽性菌株中,革蘭陰性菌488株(57.8%)、革蘭陽性菌332株(39.3%)、真菌24株(2.9%);革蘭陽性菌中,主要是凝固酶陰性葡萄球菌(25.5%)、腸球菌屬(4.6%)和金黃色葡萄球菌(4.3%),革蘭陰性菌中主要是大腸埃希菌(23.9%)、肺炎克雷伯菌(13.4%)和鮑曼不動(dòng)桿菌(5.0%);葡萄球菌對(duì)青霉素類、紅霉素、氟喹諾酮類藥物耐藥性較高,耐甲氧西林凝固酶陰性葡萄球菌和耐甲氧西林金黃色葡萄球菌分別占66.0%和44.4%,金黃色葡萄球菌對(duì)萬古霉素和利奈唑胺100%敏感,凝固酶陰性葡萄球菌對(duì)萬古霉素的耐藥率是4.4%。腸球菌屬耐藥率較高,僅對(duì)萬古霉素和利奈唑胺敏感性較好;大腸埃希菌中,產(chǎn)ESBLs菌株占50%,對(duì)哌拉西林/三唑巴坦和頭孢哌酮/舒巴坦的敏感性較好,未檢出亞胺培南耐藥株;肺炎克雷伯菌產(chǎn)ESBLs菌株占25.7%,對(duì)常見藥物均表現(xiàn)較好的敏感性,亞胺培南耐藥率2.7%;鮑曼不動(dòng)桿菌存在嚴(yán)重的多重耐藥現(xiàn)象,對(duì)常用抗菌藥物的耐藥率都在70%以上(包括亞胺培南)。結(jié)論嘉興地區(qū)血流感染病原菌分布廣泛,革蘭陰性菌主要分布在肝膽外科、泌尿外科等外科病區(qū),革蘭陽性菌主要分布在ICU病區(qū);不同病原菌間耐藥性差異較大,臨床應(yīng)根據(jù)各科室血流感染流行病原菌合理選擇經(jīng)驗(yàn)用藥,避免耐藥性上升。
[Abstract]:Objective to analyze retrospectively the distribution and drug resistance of pathogenic bacteria in the second affiliated hospital of Jiaxing Medical College from January 2013 to December 2015 in order to provide theoretical basis for rational clinical use of drugs. Methods Blood culture samples were collected from January 2013 to December 2015, and blood culture was carried out by Bac T/Alert 3D automatic blood culture instrument and BactecFX blood culture instrument. The BD-phoenix100 automatic microbial identification system and the VITEK2-Compact automatic microbial identification system were used to identify the bacteria and test the antimicrobial susceptibility of the positive strains in blood culture. ESBLs (Extended-Spectrum 尾-lactamases);) was detected by phenotypic confirmatory test in CLSI (Clinical Laboratory Standard Institute) (Extended-Spectrum 尾-lactamases);). Drug resistance was statistically analyzed by WHONET5.4 software and SPSS17.0 software. Results from January 2013 to December 2015, a total of 10633 blood culture samples were sent to clinical departments. 844 blood culture positive strains were mainly distributed in ICU (28.3%, 239 / 844), general surgery (14.5%, 122 / 844), and the blood culture positive strains were mainly distributed in the disease area (28.3%, 239 / 844) and in the general surgery area (14.5%, 122 / 844). Emergency ward (8.0%, 68 / 844) and respiratory ward (7.3%, 62 / 844). Among the positive strains in blood culture, 488 (57.8%) were Gram-negative, 332 (39.3%) were Gram-positive and 24 (2.9%) were fungi. Among gram-positive bacteria, coagulase-negative staphylococci (25.5%), Enterococcus (4.6%) and Staphylococcus aureus (4.3%), Escherichia coli (23.9%), Gram-negative bacteria (Gram-negative bacteria), Escherichia coli (23.9%), Staphylococcus aureus (4.3%) and Escherichia coli (23.9%). Klebsiella pneumoniae (13.4%) and Acinetobacter baumannii (5.0%); Staphylococcus was resistant to penicillin, erythromycin and fluoroquinolone. Methicillin-resistant coagulase-negative staphylococcus and methicillin-resistant Staphylococcus aureus accounted for 66. 0% and 44. 4%, respectively. Staphylococcus aureus was 100% sensitive to vancomycin and ranizolamine while coagulase negative staphylococcus was 4.4% resistant to vancomycin. The resistance rate of Enterococci to vancomycin and ranizolamine was higher than that of Enterococci. In Escherichia coli, 50% of the strains producing ESBLs were sensitive to piperacillin / triazobactam and cefoperazone / sulbactam, and no imipenem resistant strains were detected. ESBLs-producing strains of Klebsiella pneumoniae accounted for 25.7% and showed good sensitivity to common drugs. Imipenem resistance rate was 2.7%. Acinetobacter baumannii has serious multi-drug resistance, and the resistance rate to commonly used antibiotics is more than 70% (including imipenem). Conclusion Gram-negative bacteria are mainly distributed in hepatobiliary surgery, urology and other surgical areas, and Gram-positive bacteria are mainly distributed in ICU disease area in Jiaxing area. There are great differences in drug resistance among different pathogenic bacteria. In order to avoid the increase of drug resistance, drug use should be reasonably selected according to the epidemiological protozoa of blood flow infection in different departments.
【作者單位】： 嘉興醫(yī)學(xué)院附屬第二醫(yī)院檢驗(yàn)科;
【分類號(hào)】：R446.5

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