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目的调查武汉大学人民医院革兰阴性菌血流感染的病原体分布及耐药现状,为临床医生抗感染治疗提供依据。方法血培养采用Bac T/Alert 3D全自动血培养仪,利用Phoenix-100微生物全自动鉴定药敏仪进行病原体鉴定及药敏试验,按照2013年美国临床实验室标准化协会(CLSI)标准判读结果,采用WHONET5.6和Excel统计分析。结果 2013年3月-2016年3月该院血培养阳性率为7.8%(1938/24735),其中共分离得到822株革兰阴性细菌,占比42.2%。前四位的革兰阴性杆菌分别是大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌,分别占比51.5%、19.1%、6.4%、4.7%。1株碳青霉烯中介的大肠埃希菌,3株碳青霉烯耐药的肺炎克雷伯菌;铜绿假单胞菌对亚胺培南、美罗培南敏感性分别为83%、90.6%,鲍曼不动杆菌对亚胺培南、美罗培南敏感性分别为18.4%、15.8%。结论大肠埃希菌检出率位列第一,鲍曼不动杆菌耐药严重,临床医生应了解本地区血流感染病原微生物分布以及耐药性,合理用药,减少耐药菌的产生和播散。
Objective To investigate the distribution of pathogens and the drug resistance status of Gram-negative bloodstream infections in People’s Hospital of Wuhan University, and provide the basis for anti-infection treatment of clinicians. Methods The blood culture method was Bac T / Alert 3D automated blood culture instrument. Pathogen identification and drug susceptibility testing were conducted by using the Phoenix-100 automatic microbial identification system. According to the CLSI standard interpretation results in 2013, Using WHONET5.6 and Excel statistical analysis. Results The positive rate of blood culture in this hospital from March 2013 to March 2016 was 7.8% (1938/24735), of which 822 Gram-negative bacteria were isolated, accounting for 42.2%. The top four Gram-negative bacilli were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii, accounting for 51.5%, 19.1%, 6.4% and 4.7% respectively. 1 carbapenem-mediated Escherichia coli and 3 carbapenem-resistant Klebsiella pneumoniae. The susceptibilities of Pseudomonas aeruginosa to imipenem and meropenem were 83% and 90.6% Acinetobacter baumannii to imipenem, meropenem sensitivity were 18.4%, 15.8%. Conclusions The detection rate of Escherichia coli is the highest, and Acinetobacter baumannii is seriously drug-resistant. Clinicians should understand the distribution of pathogenic microorganisms and drug-resistance of blood-borne pathogens in the area, and use them rationally to reduce the production and propagation of resistant bacteria Scattered