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Distribution and antimicrobial resistance analysis of bacteria isolated from blood cultures in a hospitalObjective:To provide reference for empirical medication of bloodstream infection(BSI)by analyzing the distribution and antimicrobial resistance of main bacteria isolated from blood cultures in a hospital.Methods:The pathogenic bacteria distribution and antimicrobial resistance of 1798 strains isolated from blood cultures in a hospital from January 2013 to December 2018 were retrospectively analyzed.SPSS 21.0 software was used for statistical analysis.Results:1.Detection of pathogenic bacteriaOf the 1798 strains isolated from blood cultures,1243 strains(69.1%)were Gram-negative bacteria,474 strains(26.4%)were Gram-positive bacteria and 81 strains(4.5%)were fungi.Compared with the rate from 2013 to 2015,the detection rate of Gram-negative bacteria decreased significantly from 2016 to 2018,while the detection rate of Gram-positive bacteria increased significantly(P<0.05).The top five isolated bacteria were Escherichia coli(530 strains,for 29.5%),Klebsiella pneumoniae(299 strains,for 16.6%),Staphylococcus aureus(113 strains,for 6.3%),Enterococcus(110 strains,for 6.1%)and Acinetobacter baumannii(102 strains,for 5.7%).Compared with the rate from 2013 to 2015,the isolation rate of Klebsiella pneumoniae from 2016-2018 increased significantly,and there was no significant change in other bacteria.2.Sensitivity change of major Gram-negative bacteriaThe sensitivity of Escherichia coli to most common antibiotics(except Cephazolin and Gentamicin)is relatively stable.The sensitivity of Klebsiella pneumoniae to common antibiotics(except Ampicillin/Sulbactam and Cefuroxime)decreased significantly(P<0.05).The sensitivity of Acinetobacter baumannii to commonly applied antibiotics trended downward,among which the sensitivity to Levofloxacin,Ciprofloxacin,Gentamicin and Tobramycin decreased significantly(P<0.05).The sensitivity of Pseudomonas aeruginosa to common utilized antibiotics(except Ceftazidime)trended downward without statistical significance.The sensitivity of Klebsiella pneumoniae,Acinetobacter baumannii and Pseudomonas aeruginosa to Carbapenems decreased from 94.0%,41.2% and 81.5% to 68.8%,23.5% and 64.3%,respectively.3.Sensitivity change of major Gram-positive bacteriaThe sensitivity of Staphylococcus aureus,coagulase-negative Staphylococcus,Enterococcus faecium and Enterococcus faecalis to most common antibiotics had no significant change.The detection rates of Methicillin-resistant Staphylococcus aureus and coagulase-negative Staphylococcus increased from 18.9% and 75.0%(2013-2015)to 28.9% and 88.0%(2016-2018),respectively,but without statistical significance.The sensitivity rate of Staphylococcus to Vancomycin,Linezolid and Tegecycline was 100.0%.Conclusions:1.The main bacteria isolated from blood cultures were Gram-negative bacteria,but the detection rate of Gram-positive bacteria trended upward,and the main bacteria detected were Escherichia coli,Klebsiella pneumoniae and Staphylococcus aureus.Over the past 6 years,the detection rate of Klebsiella pneumoniae has increased significantly.2.Compared with the sensitivity from 2013 to 2015,there was no significant change in the sensitivity of Escherichia coli and Pseudomonas aeruginosa to most commonly used antibiotics from 2016 to 2018.The sensitivity of Klebsiella pneumoniae and Acinetobacter baumannii to most antibiotics reduced significantly.The detection rate of Carbapenem-resistant Klebsiella pneumoniae,Acinetobacter baumannii and Pseudomonas aeruginosa increased.3.Compared with the sensitivity from 2013 to 2015,there was no significant change in the sensitivity of Staphylococcus and Enterococcus to most commonly used antibiotics from 2016 to 2018.The detection rate of methicillin-resistant Staphylococcus increased.No Staphylococcus resistant to Vancomycin,Linezolid and Tegecycline was detected.Part ? Clinical characteristics of Gram-positive cocci bloodstream infectionObjective:Analyze the influencing factors of the clinical selection of special-use grade antibacterial drugs and evaluate the rationality of their use,to provide a basis for strengthening the management of special-use grade antibacterial drugs.Methods:1.The medical records of patients diagnosed with Gram-positive cocci BSI from January to December 2018 in our hospital were retrospectively investigated to analyze the clinical and microbiological data of the patients.All medical records were divided into Treatment group using special-use grade antibacterial drugs(group 1)and Treatment group using non-special-use grade antibacterial drugs(group 2)according to whether special-use grade antibacterial drugs were selected for treatment.Univariate and multivariate logistics regression analysis was applied to analyze the influencing factors of clinicians' selection of special-use grade antibacterial drugs for the treatment of Gram-positive cocci BSI.2.Referring to Guiding Principles of Clinical Use of Antimicrobial Drugs,medicine operation instructions and relevant literatures,the Evaluation Criteria for the Rational Use of Linezolid/Norvancomycin in Bloodstream Infections were developed and evaluated in five aspects: drug selection,usage and dosage,course of treatment,combination of antibiotics and drug interactions.Results:1.Pathogens and department distributionA total of 114 patients with Gram-positive cocci BSI were included in the study,and 120 Gram-positive cocci were isolated,of which 108 single Gram-positive cocci infection,6 combined with other Gram-positive cocci infection.In addition,there were 11 patients mixed infections with Gram-negative bacilli and 5 patients mixed infections with fungi.The pathogen with the highest detection rate was Staphylococcus aureus in 35 strains(29.2%),followed by Streptococcus species in 33 strains(27.5%)and coagulase-negative staphylococci in 22 strains(18.3%).A total of 27 strains of multidrug-resistant bacteria were detected,including 7 MRSA,19 MRCNS and 1 VRE.The main departments of occurring Gram-positive cocci BSI were surgical intensive care unit in 22 patients(19.3%),nephrology in 19 patients(16.7%)and medical intensive care unit in 10 patients(8.8%).2.Analysis of factors influencing the selection of special-use grade antibacterial drugsUnivariate and multivariate logistics regression analysis indicated that gender,age,combined underlying diseases and mixed infections were not associated with the selection of special-use grade antimicrobial drugs(P>0.05).multidrug-resistant bacteria,multisite infection and combination of more than three underlying diseases were independent influence factors for treatment with special-use grade antibacterial drugs(P<0.05).3.Analysis of rational use of special-use grade antibacterial drugs in Gram-positive cocci BSI Of the 114 patients,50 used special-use grade antimicrobial drugs,including norvancomycin in 40 patients and linezolid in 10 patients.From the five aspects of drug selection,usage and dosage,course of treatment,combination of antibacterial drugs and drug interaction,a total of 59 cases of irrational use were found,with the highest frequency of occurrence being 18 cases(30.5%)of improper course of treatment,followed by 17 cases(28.8%)of improper usage and dosage,13 cases(22.0%)of drug interaction and 10 cases(16.9%)of improper drug selection,and only 1 cases(1.7%)of irrational combination of antibacterial drugs.Conclusions:1.Staphylococcus aureus,Streptococcus species,and coagulase-negative staphylococci were the main pathogens of Gram-positive cocci BSI in our hospital in 2018.The main departments of distribution were intensive care units and nephrology.2.Multidrug-resistant bacteria,multisite infection and combination of more than three underlying diseases were independent factors for clinicians to choose the special-use grade antibacterial drugs for treatment.3.The irrational use of special-use grade antibacterial drugs in Gram-positive cocci BSI was more prominent,mainly manifested as too short course of treatment and inappropriate usage and dosage. |
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