某三甲医院9年间血培养分离细菌的分布及耐药谱分析

目的 分析某三甲医院血培养的细菌分布以及体外药敏结果，提供临床合理使用抗菌药物的依据。方法 回顾性调查云南省第二人民医院2010年1月—2018年12月，住院及门诊送检血培养标本分离培养及药物敏感试验的结果，采用 WHONET5.6软件对血培养分离到细菌的分布及药敏结果进行统计分析。结果 共检出细菌2163株，其中革兰阴性杆菌1379株(63.8%)，革兰阳性菌710株(32.8%)，真菌74株(3.4%)。在革兰阴性菌中，以大肠埃希菌为主48.1%，其次是肺炎克雷伯菌16.0%以及甲型副伤寒沙门菌11.4%；而革兰阳性菌以凝固酶阴性葡萄球菌61.0％为主，其次是金黄色葡萄球菌16.1%及屎肠球菌5.6%；真菌以白假丝酵母35.1%、近平滑假丝酵母菌20.3%及热带假丝酵母菌17.6%为主，在真菌中检出组织胞浆菌1例；检出率前3位的科室是ICU16.2%、肿瘤科15.0%及创伤中心14.4%。药敏结果显示，耐碳青酶烯酶的肺炎克雷伯菌(CRKP)检出率13.6%，耐碳青酶烯酶的大肠埃希菌(CREC)检出率0.3%，产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌的检出率分别为64.9%和36.7%；耐碳青霉烯类的鲍曼不动杆菌(CRAB)73.6%，耐碳青霉烯类的铜绿假单胞菌(CRPA)47.8%，耐甲氧西林金黄色葡萄球菌(MRSA)检出率38.6%；而检出前几位的大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌及金黄色葡萄球菌对常用的抗菌药物存在较高的耐药率，特别是产碳青霉烯酶(KPC)、产超广谱β-内酰胺酶(ESBLs)株及耐甲氧西林葡萄球菌(MRS)的耐药率较高，产酶株与非产酶株细菌的耐药率存在较大差异(P＜0.01)，甲型副伤寒沙门菌除对常用的抗菌药物具有较高的敏感性。结论

Distribution and drug resistance spectrum of bacteria isolated #br# from blood culture during nine years in a tertiary hospital

Objective To analyze bacterial distribution and drug sensitivity results in blood culture of patients with bloodstream infections in a top three hospital, and provides the basis for clinical rational use of antibiotics. Methods We retrospectively surveyed the results of blood culture isolation and drug sensitivity test in patients with bloodstream infections from January 2010 to December 2018 in Yunnan Second People's Hospital. The distribution of pathogens and drug susceptibility results were statistically analyzed using WHONET 5.6 software. Results A total of 2,163 strains of bacteria were detected, including 1,379 Gram-negative bacilli (63.8%), 710 Gram-positive bacteria (32.8%), and 74 fungi (3.4%). Among the Gram-negative bacteria, Escherichia coli was 48.1%, followed by Klebsiella pneumoniae 16.0% and Salmonella paratyphi A 11.4%. Gram-positive bacteria were mainly coagulase-negative staphylococci 61.0%, followed by Staphylococcus aureus 16.1% and Enterococcus faecium 5.6%. The fungus was mainly composed of 35.1% of Candida albicans, 20.3% of Candida parapsilosis, and 17.6% of Candida tropicalis. One case of histoplasma was detected in the fungus. The top three departments in the detection rate were 16.2% in ICU, 15.0% in oncology, and 14.4% in trauma center. The drug susceptibility results showed that the detection rate of K. pneumoniae (CRKP) against carbapenemase was 13.6%, and the detection rate of Escherichia coli (CREC) resistant to carbapenemase was 0.3%. The detection rates of Escherichia coli and Klebsiella pneumoniae of β-lactamase (ESBLs) were 64.9% and 36.7%, respectively. The carbapenem-resistant Acinetobacter baumannii (CRAB) was 73.6%, the carbapenem-resistant Pseudomonas aeruginosa (CRPA) was 47.8%, and the detection rate of methicillin-resistant Staphylococcus aureus (MRSA) was 38.6%. The detection of the first few Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus had a high resistance rate to commonly used antibiotics, especially carbapenemase (KPC). The extended-spectrum β-lactamase (ESBL) strain and methicillin-resistant Staphylococcus (MRS) had higher resistance rates, and the resistance rates of enzyme-producing strains and non-producing strains were significantly different (P<0.01). Salmonella paratyphi A had higher sensitivity to commonly used antibacterial drugs. Conclusion The main pathogens of bloodstream infection patients were Gram-negative bacilli, and the resistance of different pathogens to antimicrobial agents was quite different. Blood culture and in vitro susceptibility test before antibacterial use in patients with unexplained fever or suspected bloodstream infections were of great significance for clinical diagnosis and treatment of bloodstream infections and rational selection of antibacterial