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自贡3家三级综合医院血流感染病原菌的临床分布及耐药性分析
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| 篇名： | 自贡3家三级综合医院血流感染病原菌的临床分布及耐药性分析 |
| TITLE： | |
| 摘要： | 目的：了解自贡地区血流感染病原菌的临床分布及耐药情况，为本地区血流感染的诊断与治疗提供参考。方法：收集2017年1－12月自贡地区3家三级综合医院血培养阳性菌株及药敏结果，以大肠埃希菌ATCC25922、金黄色葡萄球菌ATCC25923、铜绿假单胞菌ATCC27853、肺炎链球菌ATCC49619为质控菌，采用WHONET 5.6 及SPSS 19.0软件对血流感染病原菌的临床分布和耐药性进行分析。结果：共分离细菌879株，其中革兰氏阳性菌212株（24.1％），革兰氏阴性菌667株（75.9％）；临床分布前5位的细菌分别为大肠埃希菌（50.7％）、肺炎克雷伯菌（10.2％）、金黄色葡萄球菌（6.5％）、表皮葡萄球菌（3.2％）和肺炎链球菌（2.6％）。携带病原菌患者的年龄及性别分布特点为40岁以上人群占88.5％，男女比例为1.15 ∶ 1。常见革兰氏阳性菌的耐药情况显示，未分离出耐万古霉素或利奈唑胺的金黄色葡萄球菌、凝固酶阴性葡萄球菌、粪肠球菌、屎肠球菌和肺炎链球菌，耐甲氧西林金黄色葡萄球菌（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（MRCN）的检出率分别为15.8％和64.2％；屎肠球菌较粪肠球菌对常见抗菌药物的耐药率更高，其中粪肠球菌对青霉素及氨苄西林耐药率为0，未检出耐青霉素的肺炎链球菌。常见革兰氏阴性菌的耐药情况显示，未分离出耐厄他培南的大肠埃希菌和肺炎克雷伯菌，并且这两种细菌对阿米卡星、头孢替坦、头孢吡肟、哌拉西林/他唑巴坦及亚胺培南的耐药率均较低（＜10％），这两种细菌中产超广谱β-内酰胺酶（ESBLs）菌株的检出率分别为42.2％和24.4％，产ESBLs菌株比不产ESBLs菌株对常见抗菌药物耐药率更高。非发酵菌中鲍曼不动杆菌较铜绿假单胞菌对常见抗菌药物耐药率更高，两者对亚胺培南的耐药率分别为68.8％和13.6％；未分离出耐阿米卡星及妥布霉素的铜绿假单胞菌。结论：自贡地区血流感染以肠杆菌科细菌为主，鲍曼不动杆菌的耐药性严重，应加强医院感控管理。 |
| ABSTRACT： | OBJECTIVE： To investigate the clinical distribution and drug resistance of pathogenic bacteria of bloodstream infection in Zigong area， and to provide reference for the diagnosis and treatment of bloodstream infection in the region. METHODS： The blood culture positive strains and drug susceptibility results of 3 third-class comprehensive hospital of Zigong district during Jan.-Dec. 2017 were collected. Using Escherichia coli ATCC25922， Staphylococcus aureus ATCC25923， Pseudomonas aeruginosa ATCC27853， Streptococcus pneumoniae ATCC49619 as quality control bacteria， clinical distribution and drug resistance of pathogens of bloodstream infection were analyzed by using WHONET 5.6 and SPSS 19.0 software. RESULTS： A total of 879 strains of bacteria were isolated， including 212 strains of Gram-positive bacteria （24.1％） and 667 strains of Gram-negative bacteria （75.9％）. Top 5 bacteria were E. coli （50.7％）， Klebosiella pneumoniae （10.2％）， Staphylococcus aureus （6.5％）， S. epidermidis （3.2％） and S. pneumoniae （2.6％）， respectively. The age and gender distribution of pathogenic bacteria was 88.5％ in the population over 40 years old， and the scale of male to female was 1.15 ∶ 1. Drug resistance of common Gram-positive bacteria showed that S. aureus， Coagulase negative staphylococcus， Enterococcus faecalis， Enterococcus faecium and S. pneumoniae resistant to vancomycin and linezolid were not isolated； the detection rates of MRSA and MRCN were 15.8％ and 64.2％， respectively. E. faecium was more resistant to common antibiotics than E. faecalis. Drug resistance rate of E. faecalis to penicillin and ampicillin was 0， and penicillin-resistant S. pneumoniae was not detected. The drug resistance of common Gram-negative bacteria showed that E. coli and K. pneumoniae resistant to ertapenem were not isolated. The drug resistance of two bacteria to amikacin， cefotetan， cefepime， piperacillin/tazobactam and imipenem were lower （＜10％）， among which the detection rates of ESBLs-producing stain were 42.2％ and 24.4％； detection rate of ESBLs-producing stain to common antibiotics was higher than that of non-producing ESBLs stain. The resistance of Acinetobacter baumannii was higher than that of P. aeruginosa to common antibiotics， and the resistant rates to imipenem were 68.8％ and 13.6％， respectively. And amikacin-resistant or tobramycin-resistant P. aeruginosa were not isolated. CONCLUSIONS： The bloodstream infection is mainly caused by Enterobacteriaceae in Zigong area， and the drug resistance of A. baumannii is serious. It is necessary to strengthen the hospital infection control and management. |
| 期刊： | 2019年第30卷第7期 |
| 作者： | 余建洪，李玉梅，王修全 |
| AUTHORS： | YU Jianhong，LI Yumei，WANG Xiuquan |
| 关键字： | 自贡地区；血流感染；细菌耐药性；抗菌药物 |
| KEYWORDS： | Zigong region； Bloodstream infection； Bacterial resistance； Antibiotics |
| 阅读数： | 270 次 |
| 本月下载数： | 4 次 |
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