血流感染病原菌的质谱鉴定、耐药监测及临床特征

夏金星　　黄玮　　黄颖　　汪波　　徐元宏

[關键词] 血流感染;血培养;细菌质谱鉴定;细菌分布;耐药性分析

[中图分类号] R378          [文献标识码] B          [文章编号] 1673-9701（2021）21-0114-06

Mass spectrum identification， drug resistance monitoring and clinical features of bloodstream infection pathogens

XIA Jinxing1   HUANG Wei2   HUANG Ying1    WANG Bo1    XU Yuanhong1

1.Department of Laboratory Medicine， the First Affiliated Hospital of Anhui Medical University， Hefei   230022， China; 2.Department of Medical Oncology，the First Affiliated Hospital of Anhui Medical University， Hefei   230022， China

[Abstract] Objective To analyze the characteristics of mass spectrum identification， strain distribution， drug resistance and clinical features of bloodstream infection pathogens in a tertiary hospital， so as to provide reference for clinical diagnosis and treatment. Methods A total of 15， 043 blood culture specimens were collected from outpatients and inpatients of the First Affiliated Hospital of Anhui Medical University from January to December 2019. The blood culture-positive strains were identified by MALDI-TOF mass spectrometry， and drug-susceptibilities were tested by an automatic analyzer or disk diffusion assays. The data were comprehensively analyzed by WHONET 5.6 software combined with clinical data. Results A total of 673 non-repeat strains were detected by mass spectrometry in 1315 blood culture-positive specimens， in which the Gram-positive bacteria， Gram-negative bacteria and fungi accounted for 52.30%， 46.81% and 0.89%， respectively. The coagulase-negative Staphylococcus， Escherichia coli， Klebsiella pneumoniae， Staphylococcus aureus， Acinetobacter baumannii， Enterococcus faecium， Enterococcus laecalis and Pseudomonas aeruginosa were the strains with high isolation rates （accounting for 84.40%， 568/673）. The detection rates of methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative Staphylococci were 41.90% and 67.40%， respectively， and no vancomycin and linezolid-positive strains were detected. The detection rates of extended spectrum β-lactamases in Escherichia coli and Klebsiella pneumoniae were 60.90% and 16.70%， respectively， and the resistance of different Gram-negative bacteria to carbapenems varied greatly. The Departments of Intensive Care Medicine， Infectious Diseases， Hematology and Pediatrics were the main sources of blood culture-positive strains（accounting for 54.98%， 370/673）. The gender ratio of male to female patients with bloodstream infections was nearly 3：2， and it was basically proportional to age. Conclusion The advantages of mass spectrum identification in bloodstream infection pathogens are significant， with complex distribution of strains and increasing trend of drug resistance showed on it. Therefore， clinical diagnosis and treatment of bloodstream infections should be optimized and antimicrobial drugs should be used appropriately.