| Objective:To study the distribution and drug resistance of isolated bacteria in blood culture in our hospital,and to analyze the correlation between TTP and clinical practice,so as to provide evidence for early warning and rational drug use.Method:(1)retrospective analysis of all positive strains of blood flow infection in the hospital from September 2017 to December 2018,534 strains of repeated strains were removed from the same patient at the same site.The bacterial distribution and disease area distribution were analyzed.(2)The positive detection rate and alarm time of bacteria were observed and analyzed.(3)Combined with clinical practice,the application of positive alarm time(TTP)in blood culture in identifying pathogenic bacteria and contaminated bacteria was analyzed.(4)Taking the median TTP of pathogenic bacteria as the cutoff point,the TTP group was divided into low TTP group and high TTP group.The clinical data of the two groups were statistically analyzed,and the diagnostic value of TTP was analyzed using the subject work curve(ROC).Independent risk factors for patients' prognosis in Logistic regression.(5)The TTP values of the bacterial multi-drug resistance group and the non-multi-drug resistance group were compared,and the diagnostic value of the TTP values of the bacterial multi-drug resistance group was predicted by ROC curve analysis.(6)to analyze the drug resistance of pathogenic bacteria in blood culture,clinician medication and patient outcomes.Results:(1)Sebacteraceae(49.5%),staphylococcus(29.2%)and enterococcus(5.2%)were the main positive strains in 534 blood cultures.The main wards were ICU(25.1%),general surgery department(15.4%)and nephrology department(7.3%).(2)TTP?1d to check out the 323 strains(60.5%),TTP?2 d to check out the 454 strains(85.0%),TTP?3d to check out the 513 strains(96.0%),different microbial median blood culture positive for alarm in time in different,from the fastest to the slowest were enterobacteriaceae(0.57 d)< streptococcus(0.68 d)< the non-fermenting bacteria genera(0.71 d)< enterococcus(0.72 d)< staphylococcus(1.36 d)< fungal(1.98 d)< the brookings coli(2.75 d).(3)The detection rate of contaminated bacteria was 15.2% within 1d,46.5% within 1-2d,26.2% within 2-3d,12.1% within >3d.Coagulase negative staphylococcus(CNS)and gram-positive bacillus were the main pathogenic bacteria,among which 59.6% were CNS and 9.1% were gram-positive bacillus.The positive time between pathogenic bacteria and the contaminated bacteria was compared,and statistical differences were found between them(P<0.05).(4)Eliminate pollution 99 strains bacteria,the remaining 435 strains of pathogenic bacteria infection patients were analyzed,and the low TTP patients than high TTP group are more likely to occur urinary infection,severe sepsis and shock and death during hospitalization,and the difference was statistically significant(P<0.05),ROC curve analysis showed that the optimal cut-off point for predicting the mortality,sepsis and shock during hospitalization was TTP 0.67 d and TTP 0.78 d,respectively,and the curve area was 0.56 and 0.57,respectively,and the prediction accuracy is low.Logistic regression analysis showed that TTP 0.68 d,sepsis,shock and admission to ICU were three independent risk factors for prognosis(5)The TTP values of the multi-drug resistant group were compared with those of the non-multi-drug resistant group,found that except the klebsiella pneumoniae multiple drug-resistant bacteria group TTP values are higher than the multiple drug resistance,and the difference was statistically significant(P<0.05),the ROC curve analysis TTP value prediction of e.coli,methicillin-resistant staphylococcus aureus(MRSA),acinetobacter baumannii and sewer enterobacter best cutoff value for TTP?0.69 d,TTP?1 d,TTP?0.69 d and TTP?0.59 d,the area under the curve is 0.873,0.707,0.754 and 0.857,respectively.The accuracy is moderate.(6)Research all blood culture pathogens(excluding contaminating bacteria)susceptibility results of gram positive bacteria which mainly by the CNS,staphylococcus aureus and enterococcus is given priority to,methicillin resistant coagulase negative staphylococcus(MRCNS)were 87.8% and methicillin resistant staphylococcus aureus(MRSA)detection rate 41.9% respectively.Today,staphylococcus aureus have not been found to resistant vancomycin,Linezolid and Teicoplanin,enterococcus in excrement enterococcus and enterococcus faecalis have higher prevalence of clindamycin resistance(?91.7%).E.coli,klebsiella pneumoniae and enterobacterium cloacae were the main bacteria in the enterobacteriaceae family.The drug resistance rate of the three drugs to piperacilin-tazobactam,amikacin,imipenem and meropenem was low(9.6%),but the drug resistance rate to ampicillin was high(79.6%).Among the non-fermentative bacteria,there are many kinds of bacteria resistant to Baumannii,which are manifested as multiple drug resistance,while pseudomonas aeruginosa is highly sensitive to a variety of antibiotics.(7)Results of patients with blood flow infection in various departments: medication according to drug sensitivity results showed that the coincidence rate of empirical drug use and drug sensitivity was 55.8%,the mortality rate of patients in ICU,general surgery department,nephrology department and cadre health center was significantly lower than that of patients with experience medication(P<0.05).Conclusions:The pathogenic bacteria and their distribution in patients infected with blood flow are complex.Clinically,it is possible to preliminarily predict the type of microbial strains according to the TTP value,distinguish between pathogenic bacteria and contaminated bacteria,and judge the multiple drug resistance and infection type of bacteria. |
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