作　　者： (田颖）; (张新蕾）; (王改先）; (霍云燕）; (张海军）;

机构地区： 北京市朝阳区医院管理中心,北京100028

出　　处： 《中国消毒学杂志》 2017年第8期774-777,共4页

摘　　要： 目的研究急诊创伤患者血标本分离病原菌分布及其耐药性情况,为临床合理应用抗菌药物提供依据。方法通过细菌分离培养和鉴定技术,对北京市某急救中心急诊创伤患者送检血标本进行监测。结果从39 439份血标本中共分离出病原菌2 801株,阳性率为7.1%;剔除重复菌株后,共计1 604株。血液标本分离病原菌中,革兰阳性球菌构成比为48.8%,其中凝固酶阴性葡萄球菌占59.00%,耐甲氧西林金黄色葡萄球菌占39.8%;革兰阴性杆菌占45.8%,真菌占5.4%。葡萄球菌属对万古霉素、利奈唑胺、替考拉宁等均敏感。革兰阴性杆菌中鲍曼不动杆菌和铜绿假单胞菌对碳青霉烯类耐药率超过30%。采血前皮肤清洁方式、导管留置时间比较差异有统计学意义(P<0.05)。结论急诊创伤患者血液标本中检出革兰阳性和革兰阴性菌群比例接近,革兰阴性杆菌耐药更为严重。采血前皮肤清洁与动静脉置管长短是导致血培养感染的危险因素,应采取综合预防措施。 Objective To study the pathogenic bacteria distribution and drug resistance of emergency trauma patients＇ blood specimens,to provide basis for clinical rational use of antibacterial drugs. Methods Bacterial isolation culture and identification techniques were used to monitor the blood samples of emergency trauma patients in an emergency care center.Results 2 801 strains of pathogenic bacteria were isolated from 39 439 blood samples,and the positive rate was 7. 1%. After removing the repeated strains,a total of 1 604 strains were found. The composition of gram-positive coccus was 48.8%,including 59. 00% of the coagulase-negative Staphylococcus aureus,and 39. 8% of methicillin-resistant Staphylococcus aureus. Gram-negative bacilli accounted for 45. 8% and the fungus accounted for 5. 4%. Staphylococcus aureus was sensitive to vancomycin,linazolamide,and etc. More than 30% of the Baumani bacillus and Pseudomonas aeruginosawere resistant to carbapenems. There was a statistically significant difference between the skin cleaning methods and the time of the catheter before the blood extraction（ P〈0. 05）. Conclusion The ratio of gram-positive and gram-negative bacteria in the blood samples of emergency trauma patients was close,and the drug resistance of gram-negative bacilli was more serious. The risk factors of blood culture infection should be taken by comprehensive precautionary measures.

关 键 词： 急诊创伤 血培养 病原菌 耐药性