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目的了解烧伤病人血液感染病原菌分布及耐药特点。方法回顾性分析2013年6月至2014年6月郑州市第一人民医院烧伤病人送检的1737例血培养阳性的标本,采用美国BD公司BACTE9120全自动血培养仪及配套成人树脂需氧瓶。细菌鉴定采用法国生物梅里埃全自动微生物分析仪及配套试剂。以金黄色葡萄球菌ATCC25923,大肠埃希氏菌ATCC25922,铜绿假单胞菌ATCC27853为质控菌株(卫生部临床检验中心),并以CLSI标准为判定标准。结果检出致病菌139株,血培养阳性率8%,革兰氏阴性杆菌占60.79%,革兰氏阳性球菌占33.99%,革兰氏阴性杆菌中不动杆菌耐药率极高,大部分只对美满霉素,多粘菌素B和利奈唑胺敏感。对亚胺培南和美罗培南的耐药率逐年上升,可能与耐药基因借助转座子,整合子水平传播有关。革兰氏阳性球菌中并未分离出对万古霉素,利奈唑胺耐药或中介的葡萄球菌。结论血培养中以革兰氏阴性杆菌为主,革兰氏阳性球菌次之,且耐药情况普遍存在。因此研究烧伤病人血培养中的常见细菌及其耐药性特点,对于指导临床早期合理用药,减少耐药菌株的产生具有非常重要的意义。
Objective To understand the distribution of bloodborne pathogens and their drug resistance characteristics in burn patients. Methods A retrospective analysis was performed on 1737 blood culture positive specimens from burned patients in First People’s Hospital of Zhengzhou City from June 2013 to June 2014. The BACTE 9120 automatic blood culture instrument from BD Company of USA and matched adult resin aerobic bottles were used. Bacterial identification using French biological Merial automatic microbiological analyzer and supporting reagents. Staphylococcus aureus ATCC25923, Escherichia coli ATCC25922, Pseudomonas aeruginosa ATCC27853 as quality control strains (Ministry of Health Clinical Laboratory Center), and CLSI criteria for the determination of the standard. Results 139 strains of pathogens were detected, the positive rate of blood culture was 8%, Gram-negative bacilli accounted for 60.79% and Gram-positive cocci accounted for 33.99%. The rate of Acinetobacter was very high in Gram- Partially sensitive to minocycline, polymyxin B and linezolid. The resistance rates to imipenem and meropenem increase year by year, which may be related to the transmission of drug resistance genes by means of transposon and integron. Gram-positive cocci did not isolate vancomycin, linezolid resistant or intermediary staphylococcus. Conclusions Gram-negative bacilli are the main pathogens in blood culture, followed by Gram-positive cocci, and the prevalence of drug-resistance is common. Therefore, it is very important to study the common bacteria and its drug resistance characteristics in blood culture of burn patients, which can guide the rational use of drugs and reduce the generation of drug-resistant strains in early clinical period.