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目的研究2011—2013年安徽医科大学解放军174临床学院血培养阳性标本的病原菌分布和耐药性变迁情况,为临床合理使用抗菌药物提供依据。方法收集血培养阳性菌株,细菌鉴定和药敏分析用微生物鉴定药敏测试系统96和梅里埃VITEK 2 Compact全自动细菌鉴定及药敏分析仪,按照美国临床实验室标准化组织(CLSI)2013标准判读结果。结果自6 687份血培养标本中共检出病原菌765株,阳性率为11.4%。其中,革兰阴性菌占54.2%,革兰阳性菌占42.6%,真菌占3.1%。病原菌主要为大肠埃希菌、凝固酶阴性葡萄球菌、肺炎克雷伯菌、金黄色葡萄球菌、铜绿假单胞菌。药敏检测:万古霉素和利奈唑胺抗菌对革兰阳性菌抗菌活力最好,未发现耐药菌株;碳青霉烯类对大肠埃希菌和肺炎克雷伯菌抗菌活力最好,但鲍曼不动杆菌对其耐药率较高,多黏菌素B抗菌活力最好。结论该院患者血流感染的病原菌以革兰阴性菌较多,耐药现象严重。因此,应加强监测的分析,以指导临床合理用药物。
Objective To study the distribution of pathogenic bacteria and the change of drug resistance in blood culture positive samples from the Clinical College of PLA of Anhui Medical University from 2011 to 2013 so as to provide basis for the rational use of antibacterials in clinic. Methods Blood culture positive strains, bacterial identification and drug susceptibility analysis were collected using the Microbiological Identification Drug Sensitivity Test System 96 and Merial VITEK 2 Compact Automatic Bacterial Identification and Drug Sensitivity Analyzer, interpreted in accordance with the CLSI 2013 standard result. Results A total of 765 pathogenic bacteria were detected in 6 687 blood culture specimens, the positive rate was 11.4%. Among them, Gram-negative bacteria accounted for 54.2%, Gram-positive bacteria accounted for 42.6%, fungi accounted for 3.1%. The main pathogens are Escherichia coli, coagulase-negative staphylococcus, Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa. Susceptibility testing: vancomycin and linezolid antibacterials have the best antibacterial activity against Gram-positive bacteria, no resistant strains were found; carbapenems had the best antibacterial activity against Escherichia coli and Klebsiella pneumoniae, Acinetobacter baumannii higher resistance rate, antibacterial activity of polymyxin B best. Conclusion The pathogens of bloodstream infection in this hospital are more Gram-negative bacteria, and the drug resistance is serious. Therefore, monitoring analysis should be strengthened to guide clinical rational use of drugs.