602例血培养阳性病原菌的分布及其耐药性分析

目的:分析南京医科大学第一附属医院2011年血培养阳性菌的分布及其耐药性?方法:用BACTEC 9240 全自动血培养仪,细菌及真菌鉴定使用API系统及VITEK2自动鉴定仪,细菌药物敏感试验采用纸片扩散法(K-B法),根据CLSI 2010版判断结果,WHONET5.4软件进行统计分析?结果:4 051例血培养标本共检出602株病原菌,其中革兰阴性菌占47.5%,革兰阳性菌占45.0%,真菌占7.0%,厌氧菌占0.5%?革兰阳性菌中葡萄球菌属占62.0%,肠球菌属占18.1%,链球菌属占14.0%?未发现对利奈唑胺?万古霉素和替考拉宁耐药的葡萄球菌,检出替考拉宁中介菌株9株?肠球菌属对利奈唑胺敏感率100.0%,但检出对万古霉素和替考拉宁耐药的屎肠球菌2株?检出率较高的革兰阴性菌依次为大肠埃希菌?肺炎克雷伯菌?鲍曼不动杆菌和铜绿假单胞菌?肠杆菌科细菌对亚胺培南?美罗培南的敏感率分别为86.8%和85.8%,鲍曼不动杆菌对多种抗菌药物的耐药率较高,在50.0%以上?结论:血培养阳性病原菌种类多,并且对抗菌药物的耐药率呈上升趋势,加强耐药监测刻不容缓?

Analysis of the distribution and resistance of 602 pathogens isolated from blood culture

Objective:To investigate the distribution and resistance of positive pathogens isolated from blood culture in the First Affiliated Hospital of Nanjing Medical University in 2011. Methods:Automatic blood culture instrument of BACTEC 9240 was used for blood samples; bacteria and fungus were identified by API system and automatic detection machine of VITEK2;bacterial drug sensitivity was determined by disk diffusion method;drug sensitivity of fungi was determined by Rosco method;and Whonet 5.4 software was used for data analysis. Results:Among the 4 051 blood culture samples,602 cases showed positive.Gram-negative bacteria accounted for 47.5%,gram-positive bacteria for 45.0%,fungi for 7.0% and anaerobes for 0.5%. Of the Gram-positive bacteria,61.8% were Staphylococcus,18.0% were Enterococcus and 14.3% were Streptococcus. There was no resistance to linezolid,vancomycin and teicoplanin in Staphylococcus,while nine stains were intermediary sensitive to teicoplanin. The sensitive rate of Enterococcus to linezolid was 100.0%,but two stains of E. faecium were resistant to vancomycin or teicoplanin. The Gram-negative bacteria were composed mainly of Escherichia coli,Klbesiella pneumoniae,Acinetobacter bauamnnii and Pseudomonas aeruginosa. The sensitive rates of Enterobacteriaceae to imipenem and meropenem were 86.8% and 85.8%. Acinetobacter bauamnnii had a relatively high resistance to many antimicrobial drugs,which was above 50.0%. Conclusion:There is a variety of pathogens isolated from the blood culture,which show an increasing trend of the resistance to many antimicrobial agents. Strengthening surveillance allows of no delay.