摘要
目的调查某三甲医院近5年住院患者标本病原学送检与分布情况。方法采集2013年11月至2018年11月哈励逊国际和平医院住院患者的痰液、尿液、血液、分泌物、穿刺液等各类标本,对标本来源、科室分布及分离的病原菌分布构成进行分析。结果5年间全院送检各类标本61286份,排名前5位分别为痰培养18302份(29.9%)、痰涂片11253份(18.4%)、血培养9713份(15.8%)、尿培养6448份(10.5%)、分泌物培养6133份(10.0%),共计51849份,占84.6%;其中痰标本占比最大,达48.2%(29555/61286)。内科病房送检标本数量远高于外科病房(份:25468比10521),呼吸内科、重症医学科和急诊重症加强治疗病房(EICU)是院内病原学标本的主要来源,共占29.8%(18243/61286)。各类标本检出病原菌阳性率为23.5%(14424/61286),其中痰培养和尿培养阳性率分别为29.7%(5428/18302)、35.4%(2281/6448),而血培养阳性率仅6.6%(643/9713)。除痰培养和粪便培养外,其他标本最常见病原菌均为大肠埃希菌。尿培养最常见的前5位病原菌分别为大肠埃希菌(40.6%(926/2281)]、肺炎克雷伯菌[9.2%(210/2281)]、铜绿假单胞菌[8.2%(188/2281)]、尿肠球菌D群[6.6%(151/2281)]和白色念珠菌[3.2%(73/2281)〕;痰培养前5位分别为肺炎克雷伯菌[24.1%(1309/5428]、鲍曼不动杆菌[21.3%(1154/5428)]、铜绿假单胞菌[15.1%(818/5428)]、大肠埃希菌[6.5%(351/5428)]和嗜麦芽糖家养单胞菌[5.8%(316/5428)];血培养前5位分别为大肠埃希菌[36.5%(235/643)]、肺炎克雷伯菌[10.9%(70/643)]、铜绿假单胞菌[4.8%(31/643)〕、表皮葡萄球菌[3.4%(22/643)]和人葡萄球菌人亚种[3.3%(21/643)]。结论住院患者病原学标本主要来源于内科病房,以痰液、血液和尿液为主,检出的病原菌以革兰阴性菌为主。
Objective To investigate the detection and distribution of hospitalized specimens from a tertiary hospital over 5 years.Methods Specimens of sputum,urine,blood,secretions and puncture fluid were collected from patients admitted to the Harrison International Peace Hospital from November 2013 to November 2018.The origin of specimens,the distribution of departments and the distribution of pathogenic bacteria isolated were analyzed retrospectively.Results A total of 61 286 specimens were sent for examination during the 5 years.The top 5 specimens were sputum culture(n=18 302,29.9%),sputum smear(n=11 253,18.4%),blood culture(n=9 713,15.8%),urine culture(n=6 448,10.5%)and secretion culture(n=6 133,10.0%),accounting for 84.6%(51 849/61 286).Sputum specimens accounted for 48.2%(29 555/61 286)with the largest proportion.The number of specimens from medical wards was much higher than that from surgical wards(specimens:25 468 vs.10 521),respiratory medicine,department of critical care medicine and emergency intensive care unit(EICU)were important sources of pathogenic specimens in the hospital,accounting for 29.8%(18 243/61 286)in total.The average positive rate of all specimens was 23.5%(14 424/61 286).The positive rates of sputum culture and urine culture were 29.7%(5 428/18 302)and 35.4%(2 281/6 448),respectively,while the positive rate of blood culture was only 6.6%(643/9 713).Escherichia coli was the most common pathogen in all specimens except for sputum culture and fecal culture.Escherichia coli[40.6%(926/2 281)],Klebsiella pneumoniae[9.2%(210/2 281)],Pseudomonas aeruginosa[8.2%(188/2 281)],Enterococcus faecalis(group D)[6.6%(151/2 281)]and Candida albicans[3.2%(73/2 281)]were the most common pathogens in urine culture.Klebsiella pneumoniae[24.1%(1 309/5 428)],Acinetobacter baumannii[21.3%(1 154/5 428)],Pseudomonas aeruginosa[15.1%(818/5 428)],Escherichia coli[6.5%(351/5 428)]and Maltose oligotrophomonas maltose[5.8%(316/5 428)]were the most common pathogens in sputum culture.Escherichia coli[36.5%(235/643)],Klebsiella pneumoniae[10.9%(70/643)],Pseudomonas aeruginosa[4.8%(31/643)],Staphylococcus epidermidis[3.4%(22/643)]and Staphylococcus humanis[3.3%(21/643)]were the most common pathogens in blood culture.Conclusion Specimens sent for examination by inpatients are mainly from internal medicine wards,mainly from sputum,blood and urine,and the detected pathogens are mainly Gram-negative bacteria.
作者
林灵芝
王金荣
高攀
郭淑芬
邵立业
郭伟
马珍
崔朝勃
Lin Lingzhi;Wang Jinrong;Gao Pan;Guo Shufen;Shao Liye;Guo Wei;Ma Zhen;Cui Zhaobo(Department of Intensive Care Unit,Harrison International Peace Hospital,Hengshui 053000,Hebei,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2019年第5期629-632,共4页
Chinese Critical Care Medicine
基金
河北省医学科学研究计划项目(20130344)
河北省科技计划项目(172777108D).
关键词
住院标本
病原学检测
医院感染
Hospitalized specimen
Etiological examination
Nosocomial infection
