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目的了解安徽医科大学第一附属医院血液病患者血培养的病原菌分布和耐药性情况,为临床合理用药提供依据。方法对我院2007年1月至2009年3月血液内科送检的血液或骨髓标本,使用BACTEC-9120血培养仪培养,用MicroScanWalk Away-40微生物鉴定系统进行菌种鉴定和药敏试验。结果在1012份血液病患者的血培养标本中,共检出病原菌117株,阳性率11.6%,117株病原菌中革兰阴性菌51株(43.6%),革兰阳性菌50株(42.7%),真菌16株(13.7%),最常见的菌种依次是:大肠埃希氏菌28株(23.9%),人葡萄球菌人亚种25株(21.4%),表皮葡萄球菌10株(8.5%),肺炎克雷伯氏菌10株(8.5%),近平滑念珠菌6株(5.1%),大肠埃希氏菌和肺炎克雷伯氏菌产超广谱β-内酰胺酶(ESBLs)阳性率分别是75%和30%,耐甲氧西林凝固酶阴性的葡萄球菌(MRCNs)阳性率85.7%,病原菌出现很高的多重耐药性,对革兰阳性球菌和革兰阴性杆菌最敏感的药物是万古霉素和亚胺培南。结论本分析结果显示,我院血液科患者血流感染以大肠埃希氏菌和CNS为主,具有多重耐药性,提示临床医师应加强对血液病患者血培养的检测和合理使用药物。
Objective To understand the distribution of blood-borne pathogens and the drug resistance of patients with hematological diseases in the First Affiliated Hospital of Anhui Medical University, so as to provide the basis for clinical rational drug use. Methods Blood or bone marrow samples from our hospital from January 2007 to March 2009 were collected and cultured with BACTEC-9120 blood culture instrument. MicroScanWalk Away-40 microbial identification system was used to identify the bacteria and drug susceptibility test. Results A total of 117 pathogenic bacteria were detected in blood samples of 1012 blood disease patients, with a positive rate of 11.6%. Among the 117 pathogens, 51 (43.6%) were Gram-negative bacteria and 50 (42.7%) were Gram-positive bacteria , And 16 fungi (13.7%). The most common species were Escherichia coli 28 (23.9%), Staphylococcus aureus 25 (21.4%), Staphylococcus epidermidis 10 (8.5% ), Klebsiella pneumoniae 10 (8.5%), Candida parapsilosis 6 (5.1%), Escherichia coli and Klebsiella pneumoniae producing extended-spectrum β-lactamases (ESBLs) The positive rates were 75% and 30% respectively. The positive rate of methicillin-resistant coagulase-negative staphylococci (MRCNs) was 85.7%. The pathogenic bacteria showed high multi-drug resistance and were most sensitive to gram-positive cocci and gram-negative bacilli The drugs are vancomycin and imipenem. Conclusion The results of this analysis show that bloodstream infections in patients with hematology in our hospital are predominantly Escherichia coli and CNS with multiple drug resistance, suggesting that clinicians should strengthen the blood culture detection and rational use of drugs in patients with blood diseases.