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目的分析四川省中医院血培养阳性病原菌分布及耐药性特点,为临床诊断和制定治疗方案提供依据。方法对本院2014-2015年住院病人共6 271份血标本采用ac T/Alert3D 60/120全自动血培养仪进行培养,阳性者用VITEK-2 Compact细菌分析鉴定和药敏试验系统进行细菌鉴定及药敏实验。结果 2014年和2015年送检血标本分别为2 808份和3 463份,病原菌检出率分别为10.90%和9.88%;革兰阴性菌所占比例分别为61.43%和56.30%,前3位均为大肠埃希菌、肺炎克雷伯菌和鲍曼不动杆菌。大肠埃希菌对氨苄西林的耐药率持续偏高(≥86.0%);肺炎克雷伯菌对阿莫西林/克拉维酸及喹诺酮类的耐药率分别从37.50%、18.75%上升至81.25%、50.00%;鲍曼不动杆菌对头孢曲松和氨曲南的耐药率达100.00%。革兰阳性菌中,以凝固酶阴性葡萄球菌、金黄色葡萄球菌和屎肠球菌为主;表皮葡萄球菌对青霉素和苯唑西林的耐药率达100.00%;金黄色葡萄球菌中,MARSA检出率从22.22%上升到34.78%;表皮葡萄球菌和金黄色葡萄球菌均无呋喃妥因、替加环素、万古霉素和利奈唑胺耐药菌株。结论血流感染病原菌主要为革兰阴性细菌;病原菌对常用抗菌药物均有不同程度的耐药,临床应加强细菌耐药性监测,临床医师应根据不同细菌合理选择抗菌药物并严格遵守抗菌素使用指南。
Objective To analyze the distribution of blood-borne positive pathogens in Sichuan Provincial Hospital of Traditional Chinese Medicine and its drug resistance characteristics, so as to provide the basis for clinical diagnosis and treatment planning. Methods A total of 6 271 blood samples of inpatients from 2014 to 2015 in our hospital were collected using an ac T / Alert3D 60/120 automatic blood culture system. The positive samples were identified by VITEK-2 Compact bacterial identification and susceptibility testing system And susceptibility testing. Results The blood samples were 2 808 and 3 463 respectively in 2014 and 2015. The detection rates of pathogenic bacteria were 10.90% and 9.88% respectively. The proportions of Gram-negative bacteria were 61.43% and 56.30% Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii. The resistance rate of Escherichia coli to ampicillin continued to be high (≥86.0%). The rates of resistance to Klebsiella pneumoniae to amoxicillin / clavulanic acid and quinolones increased from 37.50% and 18.75% to 81.25% %, 50.00%. Acinetobacter baumannii resistant rate to ceftriaxone and aztreonam reached 100.00%. Gram-positive bacteria, coagulase-negative Staphylococcus aureus, Staphylococcus aureus and Enterococcus faecium; Staphylococcus epidermidis resistant to penicillin and oxacillin 100.00%; Staphylococcus aureus, MARSA detected The rate rose from 22.22% to 34.78%; Staphylococcus epidermidis and Staphylococcus aureus were nitrofurantoin, tigecycline, vancomycin and linezolid resistant strains. Conclusions The main pathogens of bloodstream infection are Gram-negative bacteria. Pathogens have different levels of resistance to common antibiotics. Clinics should strengthen the monitoring of bacterial resistance. Clinicians should choose antibacterial drugs reasonably according to different bacteria and strictly follow the antibiotic usage guidelines .