Analysis On The Distribution And Drug Resistance Of Pathogens Of Bloodstream Infection In Our Hospital From 2015 To 2018

Objective:We analyze the composition,clinical distribution and drug sensitivity of pathogens in patients of BSI(blood stream infection)in our hospital,so as to provide help for the early diagnosis and treatment of BSI and improve the survival rate of patients with BSI.Methods:Strains and clinical data of patients with BSI in the affiliated hospital of Chengde Medical College from June 2015 to April 2018 were collected.Strai-ns identification and susceptibility tests were performed using Vitek-2 Compact.Anaerobic bacteria were detected by concentration gradient method.The composition of pathogenic bacteria detected in patients with BSI in the hospital and the drug sensitivity spectrum were statistically analyzed.Meanwhile,the main departments of BSI and the distribution characteristics and drug resistance of pathogens were analyzed.Results:A total of 1,113 strains of pathogens were isolated from 1101 patients.24 patients were treated with mix bacteremia.There were 576(51.75%)strains of Gram-negative bacteria,510(45.82%)strains of Gram-positive bacteria,27(2.43%)strains of fungi.The gram-negative bacteria were mainly E.coli,followed by Brucella and K.pneumoniae.Coagulase-negative staphylococcus(CNS),S.aureus and Enterococcus were common in gram-positive bacteria.The first seven departments of the distribution of pathoges are hematology,infectious diseases,geriatrics,neonatology,pediatric,oncology and intensive care unit.The first three pathogens detected in hematology were E.coli,K.pneumoniae and CNS.In addition,fungi and anaerobe detected in this department accounted for 51.9%(14/27)and 34.7%(25/72)respectively,significantly higher than that in other departments.The department of infectious diseases mainly includes Brucella,E.coli and S.aureus.The first three pathogens detected in geriatric and oncology departments were the same as those in hematology.CNS was more common in neonatal,pediatric and intensive care unit.Resistance analysis of pathogenic bacteria in the whole hospital showed that E.coli and K.pneumoniae were highly sensitive to piperacillin/tazobactam,cefoperazone/sulbactam,amikacin and tegacycline,and the resistance rates of the two bacteria to carbapenems were 1.2% and 7.8% respectively.The detection rate of methicillin-resistant Staphylococcus aureus(MRSA)in S.aureus was 27.8%,that of methicillin-resistant coagulase negative Staphylococcus(MRCNS)in CNS was 82.2%,and all S.aureus were sensitive to vancomycin and linezolid.The drug resistance rate of E.faecium and E.faecalis to high unit gentamicin were more than 50%.All enterococci were sensitive to glycopeptides and oxazolidone antibiotics.The anaerobic bacteria were mainly Bacteroides fragilis,followed by Prevotella and Peptostreptococcus anaerobia.Anaerobic bacteria produce an average of 44.4% of the β-lactamase.The rate of Bacteroides fragilis is highest(87.5%).Notably,the drug resistance rate of E.coli isolated from hematology to gentamicin,amikacin,aztreonam,ceftazidime,cefepime,ciprofloxacin,cefoperazone/sulbactam,piperacillin/tazobactam,imipenem and meropenem was higher than that of the whole hospital.In addition,rare bacteria such as non-tuberculous mycobacterium,nocardia occasionally were detected.Conclusion:Gram-negative bacteria were slightly more than gram-positive bacteria in the pathogens of bloodstream infection in our hospital.The most detected bacteria were E.coli and CNS.The analysis of the data of drug resistance in the whole hospital showed that the detection rates of K.pneumoniae and MRCNS were relatively high,and it was necessary to focus on the monitoring of the generation mechanism,transmission route and clinical characteristics of drug-resistant strains.Bacteroides fragilis was the most common anaerobic bacteria,and the production rate of β-lactamase was the highest.The departments of BSI in our hospital were widely distributed,and each daparement has its own characteristics of bacteria.The drug resistance spectrum was also different from that of the whole hospital.Brucella was found mainly in the department of infectious diseases.The department of hematology had a high incidence of BSI,with the highest detection rate of anaerobic bacteria and fungi,and the drug resistance of E.coli was very serious.It is suggested that clinicians should choose antimicrobial agents rationally according to the results of drug sensitivity.