2016-2018年医院血培养病原菌的分布及耐药性分析

目的:分析2016-2018年医院血培养病原菌的分布及其耐药性。方法:对2016年1月至2018年12月遵义医科大学附属医院各科室送检的血标本进行培养、鉴定和药敏试验,并对主要病原菌的分布和药敏结果进行统计分析。结果:2016-2018年分别分离出病原菌1459、1647、1711株,其中革兰氏阴性杆菌分别为占57.78%、55.43%、54.24%,革兰氏阳性球菌分别占37.97%、39.34%、43.25%,真菌分别占4.25%、5.22%、2.51%。2016-2018年,大肠埃希菌对头孢呋辛、头孢曲松的耐药率逐年降低,对厄他培南耐药率呈明显的升高趋势;肺炎克雷伯菌对头孢呋辛、头孢曲松、头孢吡肟的耐药率逐年降低,对头孢哌酮/舒巴坦、氨苄西林/舒巴坦耐药率上升;凝固酶阴性葡萄球菌对左氧氟沙星、苯唑西林、庆大霉素的耐药率明显降低,对环丙沙星、克林霉素的耐药率有明显的上升趋势;金黄色葡萄球菌对环丙沙星、克林霉素的耐药率明显升高,对左氧氟沙星的耐药率明显降低,对呋喃妥因、万古霉素、利奈唑胺、替加环素均不耐药;白色假丝酵母菌、热带假丝酵母菌对两性霉素B均不耐药,白色假丝酵母菌对氟康唑、伏立康唑不耐药,热带假丝酵母菌对氟康唑、伊曲康唑均高度耐药。结论:造成血流感染(BSI)的主要病原菌为革兰氏阴性杆菌,病原菌对常用的抗菌药物都有不同程度的耐药,临床应合理使用抗菌药物,以降低耐药性,并加强医院感染控制措施减少耐药菌的传播。

Distribution and Drug Resistance Analysis of Blood Culture Pathogenic Bacteria in Hospital from 2016 to 2018

Objective: To analyze the distribution and drug resistance of blood culture pathogenic bacteria in the Hospital from2016 to 2018. Methods: The blood samples collected from various clinical departments of Affiliated Hospital of Zunyi Medical University from January 2016 to December 2018 were cultured, identified and tested for drug susceptibility. The distribution of major pathogenic bacteria and drug susceptibility results were statistically analyzed. Results: From 2016 to 2018, 1459, 1647 and 1711 strains of pathogenic bacteria were isolated, of which gram-negative bacilli accounted for 57.78%, 55.43% and 54.24%, gram-positive cocci accounted for 37.97%, 39.34% and 43.25%, and fungi accounted for 4.25%, 5.22% and 2.51%, respectively. The resistance rate of Escherichia coli to cefuroxime and ceftriaxone decreased year by year in 2016-2018, and the resistance rate to ertapenem increased significantly. The resistance rate of Klebsiella pneumoniae to cefuroxime, ceftriaxone and cefepime decreased year by year, and the resistance rate to cefoperazone/sulbactam and ampicillin/sulbactam increased. The resistance rate of coagulase-negative staphylococci to oxacillin, levofloxacin and gentamicin were significantly reduced, and the resistance rate to ciprofloxacin and clindamycin were significantly increased. The resistance rate of Staphylococcus aureus to ciprofloxacin and clindamycin were significantly increased, and the re sistance rate to levofloxacin was significantly reduced. And it was not resistant to nitrofurantoin, vancomycin, linezolid, and tigecycline.Candida albicans and Candida tropicalis were not resistant to amphotericin B. Candida albicans was not resistant to fluconazole and voriconazole, Candida tropicalis was highly resistant to fluconazole and itraconazole. Conclusion: The main pathogen causing bloodstream infection(BSI)is Gram-negative bacilli, which are resistant to commonly used antibiotics to varying degrees. Antibiotics should be rationally used in clinic to reduce drug resistance, and it can strengthen nosocomial infection control measures to reduce the spread of drug-resistant bacteria.