1 高邮市人民医院医院感染管理科，江苏 高邮 225600
2 高邮市人民医院检验科，江苏 高邮 225600
目的：分析2017—2018年高邮市人民医院血培养阳性病原菌分布及耐药性特点，为临床抗感染治疗提供依据。方法：培养采用BD BACTEC FX200全自动血培养仪；细菌、真菌鉴定及非苛养菌药敏试验采VITEK 2 COMPACT全自动微生物鉴定及药敏分析仪，链球菌药敏为纸片扩散法(K-B法)，真菌药敏采用DL-96 FUNGUS；WHONET 5.6软件进行统计分析。结果：11 352份血培养标本检出病原菌731株，其中革兰氏阴性菌、革兰氏阳性菌和真菌分别占51.44%，48.02%和0.55%。双侧单瓶阳性率(8.84%)明显高于单侧单瓶(7.58%，P=0.016)。分离率前5位菌种依次是大肠埃希菌(29.69%)、人葡萄球菌(12.04%)、表皮葡萄球菌(10.94%)、肺炎克雷伯菌(8.21%)和金黄色葡萄球菌(5.88%)。血培养阳性病原菌主要分布于：儿科、ICU、肾脏内分泌科、呼吸内科、消化内科及肿瘤血液科。大肠埃希菌对头孢菌类、喹诺酮类、妥布霉素、庆大霉素、氨苄西林舒巴坦钠、氨曲南及复方磺胺甲噁唑耐药率(23.0%~52.1%)显著高于肺炎克雷伯菌(5%~15%；P<0.05)；大肠埃希菌对哌拉西林钠他唑巴坦钠、头孢西丁、碳青霉烯类及阿米卡星(1.4%~4.1%)与肺炎克雷伯菌(1.7%~8.3%)耐药率比较，差异无统计学意义(P>0.05)。耐甲氧西林人葡萄球菌、耐甲氧西林表皮葡萄球菌检出率(分别为64.8%和70.0%)都显著高于耐甲氧西林金黄色葡萄球菌(32.6%，P<0.01)；3种葡萄球菌对达托霉素、利奈唑胺、万古霉素、奎奴普丁/达福普汀均敏感。结论：多套血培养送检有利于提高病原菌检出率，血培养检出病原菌以革兰氏阴性菌为主，血培养病原菌在不同科室的分布和耐药性不同。高度重视早期血培养，合理使用抗菌药物，可有效减少耐药菌株的产生。
Distribution and drug resistance of pathogens in blood culture specimens from 2017 to 2018
This work was supported by the Scientific Research Fund Project of Gaoyou People’s Hospital, China (GYRYKY201803).
Objective: To investigate the distribution and drug resistance of blood culture positive pathogens in Gaoyou People’s Hospital from 2017 to 2018, and to provide evidence for clinical anti-infection treatment. Methods: All blood samples were cultured by BD BACTEC FX200. Automatic detection machine of VITEK 2 COMPACT was used for identification of bacteria and fungus, as well as the susceptibility of fastidious bacteria. Susceptibility of streptococcus was tested by K-B method while susceptibility of fungus was tested by DL-96 FUNGUS. WHONET 5.6 software was used for statistical analysis. Results: A total of 731 strains of pathogenic were isolated from 11 352 blood culture specimens, 51.44%, 48.02% and 0.55% of which were gram-negative bacteria, gram-positive bacteria and fungi respectively. The positive rates of bilateral single bottle (8.84%) were significantly higher than that of unilateral single bottle (7.58%) (P=0.016). The top five bacteria were Escherichia coli (29.69%), Staphylococcus hominis (12.04%), Staphylococcus epidermidis (10.94%), Klebsiella pneumoniae (8.21%) and Staphylococcus aureus (5.88%). Blood culture positive pathogens were mainly isolated from the department of pediatrics, ICU, nephroendocrinology, respiratory medicine, gastroenterology and tumor hematology. The drug resistance rates of Escherichia coli to cephalosporins, quinolones, tobramycin, gentamicin, ampicillin sulbactam, aztreonam and compound neotamine (23.0%–52.1%) were significantly higher than those of Klebsiella pneumoniae (5%–15%) (P<0.05). The drug resistance rates of Escherichia coli to piperacillin tazobactam, cefoxitin, carbapenems and amikacin (1.4%–4.1%) and Klebsiella pneumoniae (1.7%–8.3% was not statistically significant (P>0.05). The detection rates of methicillin-resistant Staphylococcus hominis and methicillin-resistant Staphylococcus epidermidis (64.8% and 70.0% respectively) were significantly higher than those of methicillin-resistant Staphylococcus aureus (32.6%) (P<0.01). The three staphylococci were all sensitive to datromycin, linezolid, vancomycin, quinuptin/dafuptine. Conclusion: Multiple sets of inspection of blood culture helped to improve the positive rate. Gram-negative bacteria are the main pathogens detected in blood culture. The distribution and drug resistance of blood culture pathogens are different in different departments. More attention should be paid for the early blood culture. And the antibiotics should be used rationally so as to reduce the generation of drug-resistant strains effectively.
blood culture; bilateral single bottle; blood stream infection; the distribution of pathogens; drug resistance rate