858例血感染患者病原菌分布及耐药情况

目的:通过对某地区中心医院收集的临床血感染患者感染病原菌的分析,了解该地区血感染患者病原菌构成、分布及耐药特点,为临床治疗提供参考和指导。方法:收集2012年6月至2013年8月期间在某院就诊的858例血感染患者血液标本,采用BACTEC9050全自动血培养仪培养,采用VITEK 2 Compack系统和K-B琼脂纸片扩散法对阳性标本进行菌种鉴定和药敏检测。结果:血培养结果显示,在858份血培养标本中共检出阳性标本109份,每份标本都只检出一种病菌,总检出率为12.7%,革兰阳性菌占64.22%(70/109),革兰阴性菌占33.03%(36/109),真菌占0.35%%(3/109);药物敏感试验结果显示:葡萄球菌对青霉素、红霉素和复方新诺明耐药率40%;肠杆菌科细菌对氨苄西林和氯霉素耐药率40%;非发酵菌科细菌对氨苄西林,头孢他啶,头孢噻肟和氯霉素耐药率40%。结论:目前本地区临床血感染患者革兰阳性菌感染率高,以金黄色葡萄球菌和凝固酶阴性葡萄球菌为主,治疗可以首选糖肽类抗菌药物;革兰阴性菌以大肠杆菌和绿脓杆菌为主,对氨苄西林、氯霉素耐药率高,大肠杆菌对头孢类抗生素的耐受较绿脓杆菌低,两种细菌感染治疗可以考虑选择单环-内酰胺类抗生素。及时准确的血培养结果及药敏试验可为临床合理选择抗菌药物提供重要依据。

Pathogens Distribution and Drug Resistance in 858 Patients with Blood Infection

Objective:To analyze pathogenic bacteria in blood of patients with blood infection of Central Hospital so as to understand pathogens composition, distribution and drug resistance and to provide basis for clinical treatment.Methods:Collecting 858 blood specimens from patients with blood infection from June 2012 to August 2013, using BACTEC9050 automated blood culture system for blood specimens culture, and VITEK 2 Compack microbial systemand K-B method for strain identification and susceptibility testing of positive blood cultures were used.Results:Blood culture results: 109 positive samples were detected in 858 specimen, only one germ in each specimen, total detection rate for 12.7%. Gram-positive bacteria accounted for 64.22% (70/109), Gram-negative bacteria accounted for 33.03% (36/109), fungi accounted for 0.35% (3/109); Drug sensitivity test results: Staphylococcus to penicillin, erythromycin and cotrimoxazole resistance rate of > 40%; Enterobacteriaceae to ampicillin and chloramphenicol resistant rate of > 40%; non-fermenting bacteria to ampicillin, ceftazidime, cefotaxime and chloramphenicol resistance rate of > 40%.Conclusion:Infection rate of gram positive bacteria in the local clinical patients with blood infection is high, especially S.aureus and coagulase negative staphylococcus. Treatment can be preferred glycopeptide antibiotics; Gram negative bacteria are mainly and . They resist ampicillin and chloramphenicol highly, and we can select Single ring-lactam in the treatment. Timely and accurate results of blood cultures and drug sensitivity test can provide important basis for reasonable selection of antibiotics.