CAJ | 학술논문

目的：了解该院血培养标本中检出病原菌的分布及耐药情况，为临床合理选用抗菌药物提供依据。方法对该院2011年1月至2012年6月的血培养结果进行回顾性分析。结果血培养标本培养3164份，阳性标本418份，占13.21％。革兰阳性菌176株，占阳性菌的42.11％，以金黄色葡萄球菌及凝固酶阴性葡萄球菌为主；革兰阴性菌235株，占阳性菌的56.22％，以大肠埃希菌及肺炎克雷伯菌为主；假丝酵母菌7株，占阳性菌的1.67％。送检标本最多的分别是新生儿科（627份）、血液科（367份）、呼吸科（272份）、儿科（207份）、神经内科（185份）、ICU（158份）。菌株分出率居前的分别肝胆外科（22.22％）、内分泌科（18.18％）、脊柱外科（16.36％）、ICU （15.96％）、神经外科（15.62％）、神经内科（15.13％）、肿瘤科（13.92％）、泌尿外科（12.23％）、烧伤儿外（12.15％）和骨外科（10.25％）。主要革兰阳性菌中，葡萄球菌对青霉素、红霉素、克林霉素、复方新诺明有很高的耐药性，凝固酶阴性葡萄球菌对喹喏酮类有较高的耐药性，尚未发现耐万古霉素和利奈唑胺的葡萄球菌。阴性杆菌中肠杆菌科细菌对亚胺培南、厄他培南、阿米卡星都有很强的敏感性；大肠埃希菌对青霉素、头孢类、氨曲南、喹喏酮类、复方新诺明、庆大霉素、妥布霉素都有较高的耐药性，均在40％以上，对氨苄西林、氨苄西林／舒巴坦的耐药率在90％左右，但对哌拉西林／他唑巴坦很敏感，耐药率小于5％；肺炎克雷伯菌的耐药性较低，只有氨苄西林、呋喃妥因的耐药率在90％以上，其他均在30％以下；阴沟肠杆菌对氨苄西林、氨苄西林／舒巴坦、第三代头孢、妥布霉素、头孢替坦、呋喃妥因的耐药性均较高，对第四代头孢、哌拉西林／他唑巴坦、喹喏酮类的耐药性较低。结论血培养病原菌种类复杂，以条件致病菌为主，耐药性较强，因此，临床应加强疑为败血症患者的血培养标本检测，尽早准确合理应用抗菌药物，提高治愈率。目的：瞭解該院血培養標本中檢齣病原菌的分佈及耐藥情況，為臨床閤理選用抗菌藥物提供依據。方法對該院2011年1月至2012年6月的血培養結果進行迴顧性分析。結果血培養標本培養3164份，暘性標本418份，佔13.21％。革蘭暘性菌176株，佔暘性菌的42.11％，以金黃色葡萄毬菌及凝固酶陰性葡萄毬菌為主；革蘭陰性菌235株，佔暘性菌的56.22％，以大腸埃希菌及肺炎剋雷伯菌為主；假絲酵母菌7株，佔暘性菌的1.67％。送檢標本最多的分彆是新生兒科（627份）、血液科（367份）、呼吸科（272份）、兒科（207份）、神經內科（185份）、ICU（158份）。菌株分齣率居前的分彆肝膽外科（22.22％）、內分泌科（18.18％）、脊柱外科（16.36％）、ICU （15.96％）、神經外科（15.62％）、神經內科（15.13％）、腫瘤科（13.92％）、泌尿外科（12.23％）、燒傷兒外（12.15％）和骨外科（10.25％）。主要革蘭暘性菌中，葡萄毬菌對青黴素、紅黴素、剋林黴素、複方新諾明有很高的耐藥性，凝固酶陰性葡萄毬菌對喹喏酮類有較高的耐藥性，尚未髮現耐萬古黴素和利奈唑胺的葡萄毬菌。陰性桿菌中腸桿菌科細菌對亞胺培南、阨他培南、阿米卡星都有很彊的敏感性；大腸埃希菌對青黴素、頭孢類、氨麯南、喹喏酮類、複方新諾明、慶大黴素、妥佈黴素都有較高的耐藥性，均在40％以上，對氨芐西林、氨芐西林／舒巴坦的耐藥率在90％左右，但對哌拉西林／他唑巴坦很敏感，耐藥率小于5％；肺炎剋雷伯菌的耐藥性較低，隻有氨芐西林、呋喃妥因的耐藥率在90％以上，其他均在30％以下；陰溝腸桿菌對氨芐西林、氨芐西林／舒巴坦、第三代頭孢、妥佈黴素、頭孢替坦、呋喃妥因的耐藥性均較高，對第四代頭孢、哌拉西林／他唑巴坦、喹喏酮類的耐藥性較低。結論血培養病原菌種類複雜，以條件緻病菌為主，耐藥性較彊，因此，臨床應加彊疑為敗血癥患者的血培養標本檢測，儘早準確閤理應用抗菌藥物，提高治愈率。
목적：료해해원혈배양표본중검출병원균적분포급내약정황，위림상합리선용항균약물제공의거。방법대해원2011년1월지2012년6월적혈배양결과진행회고성분석。결과혈배양표본배양3164빈，양성표본418빈，점13.21％。혁란양성균176주，점양성균적42.11％，이금황색포도구균급응고매음성포도구균위주；혁란음성균235주，점양성균적56.22％，이대장애희균급폐염극뢰백균위주；가사효모균7주，점양성균적1.67％。송검표본최다적분별시신생인과（627빈）、혈액과（367빈）、호흡과（272빈）、인과（207빈）、신경내과（185빈）、ICU（158빈）。균주분출솔거전적분별간담외과（22.22％）、내분비과（18.18％）、척주외과（16.36％）、ICU （15.96％）、신경외과（15.62％）、신경내과（15.13％）、종류과（13.92％）、비뇨외과（12.23％）、소상인외（12.15％）화골외과（10.25％）。주요혁란양성균중，포도구균대청매소、홍매소、극림매소、복방신낙명유흔고적내약성，응고매음성포도구균대규야동류유교고적내약성，상미발현내만고매소화리내서알적포도구균。음성간균중장간균과세균대아알배남、액타배남、아미잡성도유흔강적민감성；대장애희균대청매소、두포류、안곡남、규야동류、복방신낙명、경대매소、타포매소도유교고적내약성，균재40％이상，대안변서림、안변서림／서파탄적내약솔재90％좌우，단대고랍서림／타서파탄흔민감，내약솔소우5％；폐염극뢰백균적내약성교저，지유안변서림、부남타인적내약솔재90％이상，기타균재30％이하；음구장간균대안변서림、안변서림／서파탄、제삼대두포、타포매소、두포체탄、부남타인적내약성균교고，대제사대두포、고랍서림／타서파탄、규야동류적내약성교저。결론혈배양병원균충류복잡，이조건치병균위주，내약성교강，인차，림상응가강의위패혈증환자적혈배양표본검측，진조준학합리응용항균약물，제고치유솔。
Objective To understand the distribution of detected pathogens in blood culture specimens in our hospital and the drug resistance to provide the basis for clinical reasonable selection of antibacterial drugs.Methods The blood culture results in our hospital from January 2011 to June 2012 were analyzed retrospectively.Results Among 3 164 blood culture samples,418 cases were positive,accounting for 13.21%,176 strains were Gram-positive bacteria(42.11%),Staphylococcus aureus and coagulase neg-ative staphylococcus were predominant;235 stains were Gram-negative bacteria(56.22%),Escherichia coli and Klebsiella pneumon-iae were predominant;7 stains were Candida(1.67%).The most of submitted specimens were the neonatology department(627 specimens),hematology department (367 specimens),respiratory department (272 specimens),paediatric department (207 speci-mens),neurology department(185 specimens)and ICU(158 specimens).The top departments in the strain separation rate were the hepatobiliary surgery(22.22%),endocrinology(18.18%),spinal surgery(16.36%),ICU(15.96%),neurosurgery(15.62%),neu-rology(15.13%),oncology(13.92%),urological surgery (12.23%),burns and pediatric surgery (12.15%),and bone surgery (10.25%).Among mainly Gram-positive bacteria,Staphylococcus had the high resistance to penicillin,erythromycin,clindamycin and trimethoprim-sulfamethoxazole,coagulase-negative staphylococci had the high resistance to quinoiones,but vancomycin-resistant and linezolid-resistant Staphylococcus was not found.Among Gtam-negative bacilli,Enterobacteriaceae had the strong sensitivity to imipenem,ertapenem and amikacin;Escherichia coli had the higher resistance to penicillins,cephalosporins,aztreonam,quinolones, cotrimoxazole,gentamicin and tobramycin,which was more than 40%,the resistance rate to ampicillin,ampicillin/sulbactam was a-bout 90%,but Escherichia coli was more sensitive to piperacillin / tazobactam,the resistance rate was less than 5%;Klebsiella pneumoniae had the low drug resistance,only the resistance rates to ampicillin and nitrofurantoin were more than 90%,the others were 30 % or less;Enterobacter cloacae had the higher resistance to ampicillin,ampicillin/sulbactam,third generation cephalospo-rins,tobramycin,cefotetan and nitrofurantoin and the low resistance to the fourth generation cephalosporins,piperacillin / tazobac-tam and quinolones.Conclusion The pathogenic bacterial species of blood culture are complex and dominated by the conditional pathogens with strong drug resistance.Therefore,the detection of clinical blood culture specimens in the patients with suspected septicemia should be strengthened for accurately and rationally using antibacterial drugs as early as possible and increasing the cure rate.