2019 年第 9 期 第 14 卷

2016—2017年医院血流感染病原菌检出情况和报阳时间及主要菌株的耐药性分析

Pathogenic bacteria detection rate, report time and drug resistance in bloodstream infection in hospital from 2016 to 2017

作者：王丽萍金炎邵春红张仁峰范会

英文作者：

单位：250002济南，山东大学附属省立医院医学检验部

英文单位：

关键词：血流感染；病原菌；报阳时间；药敏试验

英文关键词：

• 摘要：

• 【摘要】目的    探讨2016—2017年医院血流感染病原菌检出情况、报阳时间及主要菌株的耐药性。方法    收集山东大学附属省立医院2016—2017年8 638例门诊及住院患者的血液标本，采用法国梅里埃公司 BACT / ALERT 3D 全自动血培养仪进行培养，采用VITEK MS质谱检测仪和VITEK 2 Compact全自动细菌鉴定仪进行菌株鉴定，采用纸片扩算法和仪器法进行药敏试验。分析血流感染主要病原菌的种类及构成比、科室分布、报阳时间以及主要革兰阳性球菌和革兰阴性杆菌的药敏试验结果。结果    剔除来自同一患者的重复菌株，共分离病原菌649株，革兰阴性杆菌390株（60.1%），革兰阳性球菌233株（35.9%），真菌26株（4.0%）；其中革兰阴性杆菌排前3位的分别为大肠埃希菌180株（27.7%）、肺炎克雷伯菌66株（10.2%）、铜绿假单胞菌46株（7.1%），革兰阳性球菌排前3位的分别为金黄色葡萄球菌67株（10.3%）、屎肠球菌42株（6.5%）、表皮葡萄球菌31株（4.8%），真菌感染以白色假丝酵母菌为主（14株，2.2%）。98.6%（640/649）的菌株在72 h内检出。金黄色葡萄球菌对青霉素G、红霉素和克林霉素的耐药率较高，均在65%以上，对利福平和喹诺酮类比较敏感；屎肠球菌对大多数抗菌药物的耐药率均较高。大肠埃希菌和肺炎克雷伯菌对氨苄西林、哌拉西林、头孢噻肟耐药率较高，对碳青霉烯类、阿米卡星、哌拉西林/他唑巴坦较敏感；铜绿假单胞菌对大多数抗菌药物比较敏感，对亚胺培南和美罗培南耐药率偏高，分别为37.0%（17/46）和30.4%（14/46），大肠埃希菌和肺炎克雷伯菌对亚胺培南的耐药率分别为3.3%（6/180）、9.1%（6/66），对美罗培南的耐药率分别为2.8%（5/180）、9.1%（6/66）。结论    我院2016—2017年血流感染病原菌种类分布广，大多数病原菌报阳时间在72 h内，临床应重视血培养及药敏试验，合理使用抗菌药物，减少耐药菌株的产生。

• 【Abstract】Objective    To investigate the detection rate, report time and drug resistance of pathogenic bacteria separated from bloodstream infection in 2016-2017. Methods    Blood specimens were collected from 8 638 patients at Shandong Provincial Hospital Affiliated to Shandong University from 2016 to 2017. BioMerieux BACT/ALERT 3D, VITEK MS mass spectrometer and VITEK 2 Compact were used for blood culture and bacteria identification. Antimicrobial susceptibility was tested using K-B method and VITEK 2 Compact. Main pathogen strains and the detection rate, distribution in different departments, report time, drug sensitivities of Gram-positive cocci and Gram-negative bacilli were analyzed. Results    A total of 649 strains of pathogenic bacteria were isolated, including 390 strains of Gram-negative bacilli(60.1%), 233 strains of Gram-positive cocci(35.9%) and 26 strains of fungi(4.0%). The top three Gram-negative bacilli were Escherichia coli(180, 27.7%), Klebsiella pneumoniae(66, 10.2%) and Pseudomonas aeruginosa(46, 7.1%). The top three Gram-positive cocci were Staphylococcus aureus(67, 10.3%), Enterococcus faecium(42, 6.5%) and Staphylococcus epidermidis(31, 4.8%). Candida albicans was the main fungal infection pathogen(14, 2.2%). Most strains［98.6%（640/649）］ were reported within 72 hours. Staphylococcus aureus was resistant to penicillin G, erythromycin, clindamycin(resistance rate＞65%) and sensitive to rifampicin and quinolones. Enterococcus faecium was resistant to most antibiotic agents. Escherichia coli and Klebsiella pneumoniae were resistant to ampicillin, piperacillin, cefotaxime and sensitive to carbapenems, amikacin, piperacillin/tazobactam. Pseudomonas aeruginosa was sensitive to most antibiotic agents; its resistant rates to imipenem and meropenem were 37.0%（17/46） and 30.4%（14/46）. Resistance rates of Escherichia coli and Klebsiella pneumoniae to imipenem were 3.3%（6/180） and 9.1%（6/66）. Resistance rates of Escherichia coli and Klebsiella pneumoniae to meropenem were 2.8%（5/180） and 9.1%（6/66）. Conclusions    Pathogens of bloodstream infections are widely distributed in our hospital in 2016-2017. Most pathogens are reported within 72 hours. Clinical attention should be paid to blood culture, drug susceptibility test and rational use of antibiotics to reduce the production of drug-resistant strains.