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目的了解ICU血培养病原菌的分布及耐药性,为血流感染的经验性治疗提供参考。方法对2011年1月—2015年12月ICU血培养分离的病原菌进行细菌鉴定及药敏分析,使用WHONET 5.4软件进行统计分析。结果 6852份血培养标本中共检测出病原菌323株,阳性率为4.71%;其中革兰阴性菌、革兰阳性菌及真菌占比分别为56.97%,33.43%和9.60%。革兰阴性菌排名前4位依次为肺炎克雷伯菌(14.55%)、鲍曼不动杆菌(13.93%)、洋葱伯克霍尔德菌(7.74%)及大肠埃希菌(4.64%);前4位革兰阳性菌依次为溶血葡萄球菌(6.50%)、表皮葡萄球菌(6.19%)、屎肠球菌(4.02%)及粪肠球菌(3.72%)。肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌及洋葱伯克霍尔德菌对亚胺培南的耐药率分别为19.15%、0.00%、60.00%和40.00%。未发现耐万古霉素和利奈唑胺的葡萄球菌及粪肠球菌,但屎肠球菌对利奈唑胺耐药率已达23.08%。结论 ICU血培养分离的病原菌以肠杆菌和非发酵菌为主,大部分呈现高耐药和多药耐药的特点;已出现耐碳青酶烯类的肺炎克雷伯菌及耐利奈唑胺的屎肠球菌,需继续重点监测。
Objective To understand the distribution and drug resistance of ICU blood culture pathogens and provide reference for the empirical treatment of bloodstream infections. Methods The bacterial identification and drug susceptibility analysis of ICU blood culture isolates from January 2011 to December 2015 were performed. The data were analyzed by WHONET 5.4 software. Results A total of 323 strains of pathogens were detected in 6852 blood culture samples, the positive rate was 4.71%. The proportion of Gram-negative bacteria, Gram-positive bacteria and fungi were 56.97%, 33.43% and 9.60% respectively. The top 4 gram-negative bacteria were Klebsiella pneumoniae (14.55%), Acinetobacter baumannii (13.93%), Burkholderia cepacia (7.74%) and Escherichia coli (4.64%), ; The first four Gram-positive bacteria followed by Staphylococcus aureus (6.50%), Staphylococcus epidermidis (6.19%), Enterococcus faecium (4.02%) and Enterococcus faecalis (3.72%). The resistant rate of Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii and Burkholderia cepacia to imipenem were 19.15%, 0.00%, 60.00% and 40.00%, respectively. No vancomycin and linezolid-resistant Staphylococcus aureus and Enterococcus faecalis were found, but Enterococcus faecium had a resistance rate of 23.08% to Linezolid. Conclusions The pathogenic bacteria isolated from blood culture in ICU are mainly Enterobacteriaceae and non-fermentative bacteria, most of which are characterized by high resistance and multi-drug resistance. Some strains of Klebsiella pneumoniae and resistant to linezolid Enterococcus faecium, need to continue to focus on monitoring.