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目的了解上海长海医院血流感染患者的病原菌分布及其对抗菌药物的耐药性,为临床合理用药提供依据。方法采用自动化仪器法和纸片扩散法(K-B法)对分离于2013年1月至2014年12月的菌株进行药物敏感性试验,参照2014版CLSI M100-S24标准判断药敏结果,替加环素的判读参照FDA标准,头孢哌酮-舒巴坦的判读参照头孢哌酮标准(2014年CLSI M100-S24)。结果从血流感染患者中共分离出非重复细菌1 048株,排名前3位的为大肠埃希菌(29.5%)、凝固酶阴性葡萄球菌(15.8%)和肺炎克雷伯菌(13.8%)。细菌总数位于前5位的科室分别为消化内科、血液内科、普外科、泌尿外科和感染科。不同科室分离出的细菌种类和数目不同。药敏结果显示,产超广谱β内酰胺酶(ESBL)的大肠埃希菌和肺炎克雷伯菌分别为63.8%和38.6%,耐甲氧西林凝固酶阴性葡萄球菌占该菌总数的77.6%。泌尿外科分离的大肠埃希菌对头孢菌素耐药率高于总体水平,而消化内科分离的大肠埃希菌对β内酰胺类-酶抑制剂复合制剂和碳青霉烯类抗生素的耐药率高于总体水平和其他科室。血液内科、泌尿外科和神经外科分离的凝固酶阴性葡萄球菌对甲氧西林的耐药率较高,神经外科分离菌耐药率更为100%。烧伤监护室的肺炎克雷伯菌对所有检测抗菌药物的耐药率均高于总体水平,消化内科的肺炎克雷伯菌对碳青霉烯类和替加环素的耐药率高于总体水平。结论不同科室分离出的血流感染细菌分布及其对常用抗菌药物的耐药性呈现不同特点,应加强监测各重点病区的病原菌分布及其耐药性,以指导抗生素的合理应用。
Objective To understand the distribution of pathogenic bacteria in patients with bloodstream infection in Shanghai Changhai Hospital and its resistance to antimicrobial agents, so as to provide basis for clinical rational drug use. Methods The drug sensitivity test was carried out on the isolates isolated from January 2013 to December 2014 by using automated instrumentation and disk diffusion method (KB method). The susceptibility test was performed according to the 2014 CLSI M100-S24 standard, Interpretation of prime reference FDA standards, cefoperazone - sulbactam interpretation reference Cefoperazone standard (2014 CLSI M100-S24). Results A total of 1 048 non-repetitive bacteria were isolated from patients with bloodstream infection. Among the top 3 patients, Escherichia coli (29.5%), coagulase-negative staphylococci (15.8%) and Klebsiella pneumoniae (13.8% . The total number of bacteria in the top five departments were digestive medicine, blood medicine, general surgery, urology and infectious diseases. The different types and numbers of bacteria isolated in different departments. Drug susceptibility results showed that ESBL-producing Escherichia coli and Klebsiella pneumoniae were 63.8% and 38.6%, methicillin-resistant coagulase-negative Staphylococcus aureus accounted for 77.6 of the total number of bacteria %. Escherichia coli isolated from urology had a higher rate of resistance to cephalosporins than the general level, while the Escherichia coli isolated from gastroenterology was resistant to β-lactam-enzyme inhibitor complex and carbapenem antibiotics Rate higher than the overall level and other departments. Coagulase-negative staphylococci isolated from hematology, urology and neurosurgery had a higher resistance rate to methicillin and 100% more neurosurgical isolates. Klebsiella pneumoniae in burn unit was higher than the overall level of resistance to all the tested antimicrobial agents, and the rate of resistance to carbapenems and tigecycline in Klebsiella pneumoniae was higher than that of the overall Level. Conclusions The bacterial distribution of bloodstream infection isolated in different departments and its resistance to commonly used antimicrobial agents show different characteristics. The distribution of pathogens and their drug resistance in each key ward should be monitored to guide the rational application of antibiotics.