某院2006—2009年血液培养病原体分布及耐药性变迁

目的了解某院近4年血液培养标本分离的病原体构成及其耐药性，为临床合理用药提供依据。方法收集2006年1月-2009年12月该院门诊及住院患者送检的血液培养标本资料，并对其分离病原体分布及耐药性作统计分析。结果4年血液培养标本分离病原体633株，阳性率10.32%（633/6 135）。其中，革兰阴性（G-）菌240株（37.92%），革兰阳性（G+）菌354株（55.92%），假丝酵母菌属39株（6.16%）。金黄色葡萄球菌、大肠埃希菌、表皮葡萄球菌为检出病原体的前3位，分别占18.17%、17.22%、15.64%。G-菌对亚胺培南最敏感，耐药率仅为1.67%；对氨苄西林、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、氨曲南的耐药率， 2009年显著高于2006年（P＜0.05）。G+菌对万古霉素除发现2株肠球菌属菌株耐药外，未发现其他耐药菌株；对青霉素、头孢噻肟、左氧氟沙星、克林霉素、阿奇霉素的耐药率呈不断上升趋势，2009年显著高于2006年（P＜0.05）。结论该院血液培养病原体中，金黄色葡萄球菌、大肠埃希菌分别居检出G+菌和G-菌的首位，耐药菌株逐年增加；应及时检测病原体及其耐药性，指导临床合理用药。

Distribution and drug resistance of pathogens in blood cultures during 2006-2009 in a hospital

Objective To investigate the distribution and drug resistance of pathogens isolated from blood in recent 4 years in a hospital, so as to provide a basis for rational use of antimicrobial agents in clinic. Methods Blood specimens collected from outpatients and inpatients during 2006 - 2009 were cultured, and drug sensitivity tests were conducted. The distribution and drug resistance of pathogens were studied and analyzed. Results Among all blood samples in the past four years, 633 strains of pathogens were isolated, the positive isolation rate was 10. 32%（633/ 6 135）, 24（I strains （37. 92%） of which were gram-negative bacteria; 354 （55. 92%） were gram-positive bacteria; 39 （6.16%） were Candida. Staphylococcus aureus , Escherichia coli and Staphylococcus epiderrnidis were three dominant pathogens, which accounting for 18. 17%, 17. 22%, and 15. 64% respectively. Gram-negative bacteria had the most sensitive rate to imipenem, the resistant rate was only 1.67%. Compared with 2006, the resistant rates of gram-negative bacteria to ampicillin, piperacillin/tazobactam, cefoperazone/sulbactam, and aztreonam in- creased significantly in 2009 （P〈0. 05） ;Among gram-positive bacteria, there were only two vancomycin-resistant Enterococci strains, the resistant rates of gram-positive bacteria to penicillin, cefotaxime, levofloxaein, clindamycin, and azithromycin increased continuously; Compared with 2006, the resistant rates of gram positive bacteria to these antimicrobial agents in 2009 increased significantly（P〈0. 05）. Conclusion Staphylococcus aureus and Escherichia coli are the most common pathogens in gram-positive bacteria and gram-negative bacteria, respectively, drug resistance of isolated pathogens increases year by year; Monitoring on pathogens and trends of drug resistance is important for rational use of antimicrobial agents.