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目的:了解血培养分离菌的分布及耐药情况,为抗生素的合理使用提供指导。方法:采用纸片法及仪器法对2012-2014年血培养分离菌进行药敏试验,据CLSI 2012年版标准判读结果,WHONET5.6软件分析数据。结果:共分离1 878株细菌,革兰阴性菌占55.11%,革兰阳性菌占44.89%。检出率居前5位的菌种分别为大肠埃希菌、凝固酶阴性葡萄球菌(CNS)、金黄色葡萄球菌(金葡菌)、肺炎克雷伯菌和屎肠球菌。肠杆菌科对碳青霉烯类药物高度敏感,除肺炎克雷伯菌对美罗培南的耐药率达13.6%外,其他细菌的耐药率均在5.9%以下。非发酵菌对碳青霉烯类药物的耐药率逐年上升,敏感率仅为18.8%-56.2%。耐甲氧西林金葡菌(MRSA)和耐甲氧西林CNS(MRCNS)在金葡菌和CNS中的检出率分别为65.77%和83.33%,未发现耐万古霉素的葡萄球菌。屎肠球菌的耐药率明显高于粪肠球菌,两者均对氟喹诺酮类药物不敏感。结论:血培养分离菌以革兰阴性菌为主,所占比例逐年升高。血培养分离菌耐药对血流感染的治疗构成严重威胁,应引起高度重视。
Objective: To understand the distribution of blood culture isolates and drug resistance, provide guidance for the rational use of antibiotics. Methods: Drug susceptibility testing of blood culture isolates from 2012 to 2014 was conducted by the paper method and instrumental method. According to CLSI 2012 standard interpretation result and WHONET5.6 software analysis data. Results: A total of 1 788 strains of bacteria were isolated. Gram-negative bacteria accounted for 55.11% and gram-positive bacteria accounted for 44.89%. The top 5 detection strains were Escherichia coli, coagulase negative staphylococcus (CNS), Staphylococcus aureus (Staphylococcus aureus), Klebsiella pneumoniae and Enterococcus faecium. Enterobacteriaceae is highly susceptible to carbapenems, with the exception of Klebsiella pneumoniae which has a resistance rate of 13.6% to meropenem. The resistance rate of other bacteria is below 5.9%. The rate of resistance to carbapenems in non-fermentative bacteria increased year by year with the sensitivity of only 18.8% -56.2%. The detection rates of MRSA and MRCNS in S. aureus and CNS were 65.77% and 83.33%, respectively. No vancomycin-resistant staphylococci were found. Enterococcus faecium resistance rate was significantly higher than Enterococcus faecalis, both fluoroquinolones are not sensitive. Conclusion: Gram-negative bacteria are the main blood culture isolates, and their proportions have been increasing year by year. Blood culture isolates resistant to the treatment of bloodstream infections pose a serious threat, should be highly valued.