453株血培养分离菌株的分布和耐药性分析

目的:分析医院血流感染的主要病原菌的分布和耐药性,对血流感染进行及时治疗和有效的预防.方法:对我院2010年1月～12月收集3980份血培养标本培养采用BacT/Alert3D全自动血培养仪,分离菌株鉴定和药敏试验采用VITEK-2全自动细菌鉴定药敏仪,应用改良Hodge试验和EDTA协同试验进行碳青霉烯酶检测.结果:从3980份血培养标本分离出致病菌453株(11.4％),革兰阴性菌占50.4％(228/453),其中大肠埃希菌占57.0％( 130/228)、肺炎克雷伯菌占11.4％ (26/228)、鲍曼不动杆菌占6.6％( 15/228),发现2株碳青霉烯类耐药的肺炎克雷伯菌,鲍曼不动杆菌对碳青霉烯耐药为71.6％；革兰阳性菌占42.3％( 192/453),其中葡萄球菌中耐苯唑西林葡萄球菌占85.1％；真菌占5.1％( 23/453),厌氧菌占2.2％(10/453).结论:引起医院患者血流感染的主要病原菌以革兰阴性细菌为主,多重耐药菌株分离率增高,特别是出现碳青霉烯类耐药的肺炎克雷伯菌.

Bacteriologic profile and antibiogram of 453 blood culture isolates

Objective:To analyze the pattern of bacterial isolates from blood cultures and antibiotic resistance and provide guidelines of blood stream infection for choosing an effective antibiotic therapy and precaution.Methods:A total of 3980 blood samples collected during from January to December in 2010 were detected by BacT/Alert3D blood culture system.The identification and antimicrobial susceptibility of the isolates were determined by VITEK-2 system.The carbapenamase confirmatory test were detected by modified Hodge test and EDTA cooperating test.Results:A total of 453 strains were isolated from 3980 blood samples,the positive rate was 11.4%.Gram negative bacteria accounted for 50.4%(228/453),of which Escherichia.coli accounted for 57.0%(130/228)followed by Klebsiella pneumoniae 11.4%(26/228)and Acinetobacter baumannii 6.6%(15/228).Two isolates of carbapenem-resistant Klebsiella pneumoniae were detected and 71.6% isolates of Acinetobacter baumannii were carbapenem-resistant.Gram positive bacteria accounted for 42.3%(192/453),of which 85.1% isolates of Staphylococcus were methicillin-resistant.Fungi and anaerobes accounted for 5.1%(23/453)and 2.2%(10/453),respectively.Conclusion:Gram negative bacteria were the main pathogenic bacteria of blood stream infection in the hospital.The isolation rate of multi-drug resistant bacteria was increasing,especially the isolates of carbapenem-resistant Klebsiella pneumoniae emerged.