2017—2018年天津市宝坻区人民医院血流感染病原菌分布及耐药性分析

目的 探讨天津市宝坻区人民医院血流感染病原菌的分布及耐药性情况，为临床合理用药提供依据。方法 对2017-2018年天津市宝坻区人民医院血流感染病原菌的分布及耐药性进行回顾性分析。结果 共分离出病原菌365株，主要分布在普通内科、呼吸内科和儿科。其中革兰阴性菌228株，构成比为62.47%，主要为大肠埃希菌、肺炎克雷伯菌和鲍曼不动杆菌；革兰阳性菌137株，构成比为35.34%，主要为凝固酶阴性葡萄球菌和金黄色葡萄球菌；真菌8株，构成比为2.19%。大肠埃希菌、肺炎克雷伯菌对头孢菌素类、喹诺酮类和氨基糖苷类等抗菌药物存在不同程度的耐药性，但对酶抑制剂（头孢哌酮/舒巴坦、哌拉西林/他唑巴坦）较为敏感，对碳青霉烯类抗菌药物保持较高敏感性；鲍曼不动杆菌对第3代头孢菌素（头孢曲松、头孢噻肟）的耐药率达到了90%以上，对碳青霉烯类抗菌药物耐药率未超过20%。凝固酶阴性葡萄球菌和金黄色葡萄球菌对万古霉素、利奈唑胺无耐药性。目标性治疗应用抗菌药物中，革兰阴性菌所致血流感染多选择美罗培南（21.20%）、头孢哌酮/舒巴（14.96%）和哌拉西林/他唑巴坦（10.72%）；革兰阳性菌所致血流感染多选择万古霉素（19.45%）。结论 天津市宝坻区人民医院血流感染病原菌主要以革兰阴性菌为主，应加强血流感染病原菌的耐药性监测，以指导抗菌药物的合理使用。

Analysis on distribution and drug resistance of bloodstream infection pathogens in Baodi District People's Hospital of Tianjin from 2017 to 2018

Objective To investigate the distribution and drug resistance of bloodstream infection pathogens in Baodi District People''s Hospital of Tianjin, and to provide reference for clinical rational drug use. Methods The distribution and drug resistance of bloodstream infection pathogens in Baodi District People''s Hospital of Tianjin from 2017 to 2018 were retrospectively analyzed. Results Total 365 strains of bloodstream infection pathogens were isolated. The specimens mainly distributed in Department of General Internal Medicine, Department of Respiratory Medicine, and Department of Paediatrics. Gram-negative bacteria (228 strains) accounted for 62.47%, and main of them were Escherichia coli, Klebsiella pneumoniae, and Acinetobacter baumannii. Gram-positive bacteria bacteria were 137 strains (35.34%), and main of them were coagulase negative Staphylococcus and Staphylococcus aureus. Fungi were 8 strains, accounting for 6.81%. E. coli and K. pneumoniae had different levels of drug resistance against cephalosporins, quinolones, and aminoglycosides, but were sensitive to enzyme inhibitors (cefoperazone/sulbactam and piperacillin/tazobactam). They were highly sensitive to carbapenems antimicrobial agents. The drug resistance rate of A. baumannii against the third generation cephalosporins (ceftriaxone and cefotaxime) were above 90%, but the drug resistance rate against carbapenems antimicrobial agents were less than 20%. Coagulase negative Staphylococcus and S. aureus had no drug resistance to vancomycin and linezolid. The most common bloodstream infections caused by Gram-negative bacteria were treated by meropenem (21.20%), cefoperazone/sulbactam (14.96%), and piperacillin/tazobactam (10.72%), while the most common bloodstream infections caused by Gram-positive bacteria were treated by vancomycin (19.45%). Conclusion Gram-negative bacteria are the main pathogens causing bloodstream infections in Baodi District People''s Hospital of Tianjin. It is necessary to strengthen surveillance of drug resistance of pathogenic bacteria in blood stream infection for rational use of antibiotics.