28 292份临床血液标本细菌培养结果

Bacterial culture results of 28 292 clinical blood specimens

摘要:

目的调查某院临床送检血液标本中病原菌的分布特征。方法采用mimi VITAL全自动荧光血培养仪、Bact/ALERT 3D培养仪和VITEK32自动细菌鉴定仪对该院1999—2008年临床送检的28 292人份55 606瓶血标本进行培养鉴定，对培养结果作统计分析。结果28 292份临床血液标本进行需氧和厌氧培养，其中5 837份细菌培养阳性，阳性率20.63%；需氧生长和厌氧生长分别占阳性培养的83.50%（4 874/5 837）和82.30%（4 804/5 837）。共检出各种临床细菌43属117种5 837株，其中甲型副伤寒沙门菌4 486株,占76.85%， 2001年（1 263株）、2004年（740株）和2006 年（713株）为检出高峰年份。除外传染病因子，菌群组成以革兰阳性球菌为主，革兰阳性球菌、革兰阴性杆菌、真菌的比例为65.73∶25.30∶2.74。凝固酶阴性葡萄球菌占阳性检出菌（沙门菌属除外）的37.46%（493/1 316），居分离菌首位，并有逐年上升趋势（χ2=127.81，P＜0.01）。近年真菌的分离率也在逐渐升高（χ2=29.77，P＜0.01）。专性厌氧菌占全部分离菌的0.38%（22/5 837），占除沙门菌属外的1.67%(22/1 316)。结论同时做需氧和厌氧培养可以提高细菌培养的阳性检出率。甲型副伤寒沙门菌的持续检出和某些条件致病菌（凝固酶阴性葡萄球菌和真菌）的上升趋势应引起临床的高度关注。

Abstract:

ObjectiveTo investigate the distribution characteristics of pathogens isolated from clinical blood specimens from a hospital. MethodsBacteria isolated from 55 606 bottles of 28 292 blood specimens between 1999 and 2008 were cultured and identified by mimi VITAL Blood Culture Automation System and Bact/ALERT 3D System and VITEK 32 Automicrobic System,and the culture result was analysed statistically .ResultsIn aerobic and anaerobic culture of 28 292 blood specimens,5 837 showed positive culture results， the positive rate was 20.63%;The positive rate of aerobic and anaerobic bacteria was 83.50%(4 874/5 837) and 82.30%（4 804/5 837）respectively. A total of 5 837 strains of 117 species of 43 genus were detected, Salmonella paratyphi A accounted for 4 486 stains(76.85%).The distribution showed three peaks of bacterial detection were in the year of 2001 (1 263 strains) , 2004 (740 strains) and 2006 (713 strains). Grampositive cocci were the main isolated bacteria ,the ratio of grampositive cocci to gramnegative bacilli and fungi was 65.73∶25.30∶2.74. Coagulase negative Staphylococcus(CNS) accounted for 37.46%(493/1 316) of the detected bacteria except Salmonella spp., and had a tendency of increasing gradually(χ2=127.81,P＜0.01).The isolation rate of fungus was increasing gradually(χ2=29.77,P＜0.01). The obligate anaerobes accounted for 0.38%(22/5 837) of all isolated bacteria , and accounted for 1.67%(22/1 316) except Salmonella.Conclusion Performing both aerobic and anaerobic culture can enhance the positive detection rate. Constant detection of Salmonella paratyphi A and increasing tendency of opportunistic pathogens(CNS and fungus) should be paid much attention to .