某地区17 361株血培养分离菌的分布及耐药性分析

doi:10.3969/j.issn.1673-8640.2017.04.012

摘要/Abstract

摘要：

目的了解山东省血培养分离菌的分布特征及抗菌药物的耐药情况,为血流感染患者的经验治疗提供依据。方法对2015年1—12月山东省各医院血培养分离菌进行回顾性分析,根据美国临床实验室标准化协会（CLSI）2014年标准判读结果,采用WHONET 5.6软件统计数据。结果 2015年山东省血液样本共分离非重复菌株17 361株,其中革兰阴性杆菌9 524株,占54.9%,高于革兰阳性球菌（7 837株,占45.19%）。分离率居前5位的菌株分别为大肠埃希菌、凝固酶阴性葡萄球菌、肺炎克雷伯菌、金黄色葡萄球菌和铜绿假单胞菌。药物敏感性试验结果显示,在大肠埃希菌及肺炎克雷伯菌中产超广谱β-内酰胺酶（ESBLs）菌的检出率分别为53.5%和25.8%,产ESBLs菌对碳青霉烯类、加酶抑制剂类及头霉素类药物的耐药率较低,这3类药物可作为治疗肠杆菌科细菌感染的经验治疗药物。铜绿假单胞菌及鲍曼不动杆菌对碳青霉烯类药物耐药率较高,应慎重选择。葡萄球菌中耐甲氧西林金黄色葡萄球菌（MRSA）的检出率为27.1%,远远低于耐甲氧西林凝固酶阴性葡萄球菌（MRSCNS,80.2%）,未发现对万古霉素及利奈唑胺耐药的葡萄球菌。屎肠球菌及粪肠球菌对万古霉素的耐药率分别为1.7%和1.2%,对利奈唑胺的耐药率分别为0.7%和4.7%。万古霉素仍可以作为革兰阳性球菌所致血流感染的首选药物。结论不同地区血培养分离菌的耐药情况存在差异,了解本地区血培养分离菌的耐药情况可以指导临床合理选择抗菌药物,降低重症感染的死亡率。

关键词: 病原菌, 耐药率, 血培养, 血流感染

Abstract:

Objective To analyze the distribution and drug resistance of isolates from blood culturing in Shandong,and to provide a reference for the treatment of bloodstream infection. Methods The isolates from blood culturing were collected and analyzed retrospectively from January 2015 to December 2015 in Shandong. The results were assessed according to the Clinical and Laboratory Standards Institute （CLSI）2014 standard,and WHONET 5.6 software was used for drug resistance analysis. Results In the 17 361 isolates,Gram-negative bacilli accounted for 54.9% （9 524 isolates）,and its isolation rate was higher than that of Gram-positive cocci（accounting for 45.1%,7 837 isolates）. The top 5 isolates were Escherichia coli,coagulase-negative Staphylococcus,Klebsiella pneumoniae,Staphylococcus aureus and Pseudomonas aeruginosa. The isolation rates of extended-spectrum beta-lactamases （ESBLs）-producing Escherichia coli and Klebsiella pneumoniae were 53.5% and 25.8%,respectively. The drug resistance rates of ESBLs-producing isolates to carbapenems,oxygenase inhibitors and cephalosporin were lower. The drug resistance rates to carbapenems in Pseudomonas aeruginosa and Acinetobacter baumannii were high,and carbapenems should be chosen to use carefully. The determination rate of methicillin-resistant Staphylococcus aureus （MRSA） was 27.1%,which was less than that of methicillin-resistant coagulase-negative Staphylococcus （MRSCNS,80.2%）. No Staphylococcus resistant to vancomycin and linezolid was found. The drug resistance rates of Enterococcus faecium and Enterococcus faecalis to vancomycin were 1.7% and 1.2%,and those to linezolid were 0.7% and 4.7%. Vancomycin can be still as the first choice for Gram-positive cocci in bloodstream infection. Conclusions The analysis on the distribution and drug resistance of isolates from blood culturing could guide the rational use of medicines in clinic and reduce the mortality in severe infection.

Key words: Pathogenic bacteria, Drug resistance rate, Blood culturing, Bloodstream infection

中图分类号:

R446.5

王鑫, 白媛媛, 王翠翠, 申翠华, 金炎. 某地区17 361株血培养分离菌的分布及耐药性分析[J]. 检验医学, 2017, 32(4): 299-303.

WANG Xin, BAI Yuanyuan, WANG Cuicui, SHEN Cuihua, JIN Yan. Distribution and drug resistance of 17 361 isolates from blood culturing in a certain region[J]. Laboratory Medicine, 2017, 32(4): 299-303.

图/表 5

参考文献 13

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细菌名称	菌株数（株）	构成比（%）
革兰阴性杆菌	9 524	54.9
大肠埃希菌	5 141	29.6
肺炎克雷伯菌	1 734	10.0
铜绿假单胞菌	423	2.4
阴沟肠杆菌	283	1.6
鲍曼不动杆菌	206	1.2
其他革兰阴性杆菌	1 737	10.0
革兰阳性球菌	7 837	45.1
凝固酶阴性葡萄球菌	4 221	24.3
金黄色葡萄球菌	839	4.8
屎肠球菌	480	2.8
肺炎链球菌	287	1.7
粪肠球菌	268	1.5
其他革兰阳性球菌	1 741	10.0

细菌名称	菌株数（株）	构成比（%）
革兰阴性杆菌	9 524	54.9
大肠埃希菌	5 141	29.6
肺炎克雷伯菌	1 734	10.0
铜绿假单胞菌	423	2.4
阴沟肠杆菌	283	1.6
鲍曼不动杆菌	206	1.2
其他革兰阴性杆菌	1 737	10.0
革兰阳性球菌	7 837	45.1
凝固酶阴性葡萄球菌	4 221	24.3
金黄色葡萄球菌	839	4.8
屎肠球菌	480	2.8
肺炎链球菌	287	1.7
粪肠球菌	268	1.5
其他革兰阳性球菌	1 741	10.0

抗菌药物	大肠埃希菌（5 141株）		肺炎克雷伯菌（1 734株）		阴沟肠杆菌（283株）
抗菌药物	耐药率	敏感率	耐药率	敏感率	耐药率	敏感率
氨苄西林	80.5	15.5	-	-	-	-
哌拉西林	70.9	19.4	39.7	45.3	23.9	74.3
阿莫西林-克拉维酸	12.5	66.5	11.7	79.2	-	-
头孢哌酮-舒巴坦	5.0	81.5	6.4	85.1	11.9	80.6
哌拉西林-他唑巴坦	3.3	92.8	5.9	91.2	12.6	79.6
头孢唑啉	65.3	19.6	38.6	44.9	-	-
头孢呋辛	52.5	41.5	31.6	64.9	-	-
头孢他啶	22.9	73.6	14.6	83.2	37.2	57.5
头孢曲松	54.2	45.5	27.2	72.1	40.4	59.6
头孢噻肟	52.1	39.9	23.2	62.5	38.6	57.9
头孢吡肟	21.9	67.8	10.6	85.3	9.9	80.2
头孢西丁	11.7	80.6	10.1	85.7	-	-
氨曲南	32.8	65.0	16.8	82.2	31.9	68.1
亚胺培南	1.0	98.7	2.2	96.9	3.2	93.7
美罗培南	1.4	98.1	2.6	96.6	7.8	85.9
阿米卡星	3.0	96.0	3.0	96.9	2.3	97.1
庆大霉素	44.6	53.5	16.7	82.3	10.7	86.8
妥布霉素	20.0	53.6	9.2	77.6	8.2	90.8
环丙沙星	50.4	45.8	14.7	82.7	9.2	85.0
左氧氟沙星	48.0	47.5	11.8	86.0	14.0	76.8
复方磺胺甲噁唑	57.8	42.1	29.1	70.8	12.1	84.5

抗菌药物	大肠埃希菌（5 141株）		肺炎克雷伯菌（1 734株）		阴沟肠杆菌（283株）
抗菌药物	耐药率	敏感率	耐药率	敏感率	耐药率	敏感率
氨苄西林	80.5	15.5	-	-	-	-
哌拉西林	70.9	19.4	39.7	45.3	23.9	74.3
阿莫西林-克拉维酸	12.5	66.5	11.7	79.2	-	-
头孢哌酮-舒巴坦	5.0	81.5	6.4	85.1	11.9	80.6
哌拉西林-他唑巴坦	3.3	92.8	5.9	91.2	12.6	79.6
头孢唑啉	65.3	19.6	38.6	44.9	-	-
头孢呋辛	52.5	41.5	31.6	64.9	-	-
头孢他啶	22.9	73.6	14.6	83.2	37.2	57.5
头孢曲松	54.2	45.5	27.2	72.1	40.4	59.6
头孢噻肟	52.1	39.9	23.2	62.5	38.6	57.9
头孢吡肟	21.9	67.8	10.6	85.3	9.9	80.2
头孢西丁	11.7	80.6	10.1	85.7	-	-
氨曲南	32.8	65.0	16.8	82.2	31.9	68.1
亚胺培南	1.0	98.7	2.2	96.9	3.2	93.7
美罗培南	1.4	98.1	2.6	96.6	7.8	85.9
阿米卡星	3.0	96.0	3.0	96.9	2.3	97.1
庆大霉素	44.6	53.5	16.7	82.3	10.7	86.8
妥布霉素	20.0	53.6	9.2	77.6	8.2	90.8
环丙沙星	50.4	45.8	14.7	82.7	9.2	85.0
左氧氟沙星	48.0	47.5	11.8	86.0	14.0	76.8
复方磺胺甲噁唑	57.8	42.1	29.1	70.8	12.1	84.5

抗菌药物	鲍曼不动杆菌（206株）		铜绿假单胞菌（423株）
抗菌药物	耐药率	敏感率	耐药率	敏感率
哌拉西林	-	-	14.3	75.7
哌拉西林-他唑巴坦	66.1	29.1	9.2	78.7
头孢他啶	51.9	44.8	33.8	60.8
头孢曲松	77.2	5.0	-	-
头孢吡肟	57.0	38.8	12.2	79.0
氨曲南	-	-	24.0	52.2
亚胺培南	66.5	32.4	19.3	77.6
美罗培南	75.2	24.0	23.1	74.4
阿米卡星	50.2	45.7	9.0	85.6
庆大霉素	61.7	37.6	13.4	81.1
环丙沙星	70.9	28.7	12.8	82.4
左氧氟沙星	54.9	32.7	16.1	76.5
米诺环素	56.8	30.6	-	-