摘要
目的了解临床实验室血培养中分离出病原菌的菌种构成比及其耐药性,为临床合理用药提供实验室依据。方法对3623份患者的血液标本进行血培养,将分离出的344株细菌进行菌种鉴定,并进行药敏性分析。结果共分离病原菌344株,阳性率为9.5%,革兰阳性球菌占41.9%,最常见的是凝固酶阴性葡萄球菌,革兰阴性杆菌占53.8%,最常见的是大肠埃希菌,真菌占4.3%;病原菌科室分布ICU占25.9%,大外科占22.7%,神经内科占16.6%,呼吸内科占8.4%,血液内科占4.6%,儿科占4.2%,其他科室占17.7%;耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)占凝固酶阴性葡萄球菌的64.7%,耐甲氧西林金黄色葡萄球菌(MRSA)占金黄色葡萄球菌的41.4%;MRCNS的耐药率显著高于甲氧西林敏感的凝固酶阴性葡萄球菌(MSCNS),MRSA的耐药率显著高于甲氧西林敏感金黄色葡萄球菌(MSSA);所有葡萄球菌均对万古霉素敏感;大肠埃希菌、肺炎克雷伯菌中产ESBLs的菌株分别占23.9%、38.8%;大肠埃希菌、肺炎克雷伯菌对亚胺培南、美罗培南对的敏感性最高,无耐碳青霉烯类抗菌药物的菌株发现;产ESBLs大肠埃希菌、肺炎克雷伯菌对其他抗菌药物体现出耐药性。结论对于血液感染疾病的临床诊治,应加强实验室血培养的检测工作,了解其病原菌分布与耐药性,制定有效的抗菌治疗方案,提高治愈率。
OBJECTIVE To understand the distribution and drug resistance of the pathogens isolated from blood culture specimens in clinical laboratory so as to provide laboratory evidence for reasonable clinical use of antibiotics. METHODS Totally 3623 blood specimens were cultured, the bacterial identification of 344 strains of isolated bacteria was performed, and the drug susceptibility testing was performed. RESULTS A total of 344 strains of pathogens were isolated, the positive rate was 9. 5%. Gram-positive cocci accounted for 41. 9%, the most common was coagulase-negative Staphylococci; gram-negative bacilli accounted for 53. 8%, the most common was Escherichia coli; fungi accounted for 4. 3%. The department sources： ICU ward accounted for 25.9%, surgery department for 22.7%, department of neurology for 16.6%, respiratory medicine department for 8.4%, hematology department for 4.6%, pediatric department for 4. 2%, and other departments for 17. 7%. The methicillin-resistant coagulase-negative Staphylococcus （MRCNS） accounted for 64.7 % among the coagulase- negative Staphylococci, and the metbicillin-resistant Staphylococcus aureus accounted for 41. 4% among the S. aureusstrains. The drug resistance rate of the MRCNS was significantly higher than that of the MSCNS strains, and the drug resistance rate of the MRSA strains was significantly higher than that of the MSSA strains; All the Staphylococci strains were sensitive to vancomycin. The ESBLs-producing E. coli and K. pneurnoniae strains accounted for 23. 9% and 38. 8%, respectively, and E. coli and K. pneumoniae strains were with the highest drug susceptibility to imipenem and meropenem, and there were no carbapenem-resistant strains detected. The ESBLs-producing E. coli and K. pneurnoniae strains were resistant to other antibiotics. CONCLUSION In clinical diagnosis and treatment of blood infections, the detection of laboratory blood culture should be strengthened so as to understand the distribution and drug resistance of the pathogens, to develop the effective treatment program and to improve the cure rate.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2013年第6期1439-1441,共3页
Chinese Journal of Nosocomiology
关键词
血培养
病原菌
耐药性
药敏试验
Blood culture
Pathogen
Resistance
Drug susceptibility testing
