再探厌氧细菌血症：菌种和药敏性。

Anaerobic bacteraemia revisited: species and susceptibilities.

机构信息

Department of Laboratory Medicine, Changi General Hospital, Singapore.

出版信息

Ann Acad Med Singap. 2015 Jan;44(1):13-8.

Abstract

INTRODUCTION

This retrospective study was performed to evaluate the frequency of anaerobic bacteraemia over a 10-year period, and to provide updated antibiotic susceptibilities for the more clinically relevant anaerobes causing blood stream infection.

MATERIALS AND METHODS

Data were retrieved from the laboratory information system for the period 2003 to 2012. During this time, blood cultures were inoculated in Bactec™ Plus vials (BD, USA) and continuously monitored in the Bactec™ 9000 blood culture system (BD, USA). Anaerobic organisms were identified using commercial identification kits, predominantly API 20 A (bioMérieux, France) supplemented with Vitek ANC cards (bioMérieux, France) and AN-Ident discs (Oxoid, United Kingdom). A representative subset of isolates were retrieved from 2009 to 2011 and antimicrobial susceptibilities to penicillin, amoxicillin-clavulanate, clindamycin, imipenem, moxifloxacin, piperacillin-tazobactam and metronidazole were determined using the Etest method.

RESULTS

Anaerobes comprised 4.1% of all positive blood culture with 727 obligate anaerobes recovered over the 10-year period, representing a positivity rate of 0.35%. The only significant change in anaerobe positivity rates occurred between 2003 and 2004, with an increase of 0.2%. The Bacteroides fragilis group (45%) were the predominant anaerobic pathogens, followed by Clostridium species (12%), Propioniobacterium species (11%) and Fusobacterium species (6%). The most active in vitro antibiotics were imipenem, piperacillin-tazobactam, amoxicillin-clavulanate and metronidazole, with susceptibilities of 95.0%, 93.3%, 90.8% and 90.8% respectively. Resistance was high to penicillin, clindamycin and moxifl oxacin. However, there were apparent differences for antibiotic susceptibilities between species.

CONCLUSION

This study indicates that the anaerobes comprise a small but constant proportion of bloodstream isolates. Antibiotic resistance was high to some antibiotics, but metronidazole, the beta-lactam/beta-lactamase inhibitors and carbapenems retained good in vitro activity.

摘要

简介

本回顾性研究旨在评估 10 年间厌氧菌血症的发生频率，并为引起血流感染的更具临床相关性的厌氧菌提供最新的抗生素药敏数据。

材料与方法

数据从 2003 年至 2012 年的实验室信息系统中提取。在此期间，血培养接种于 Bactec™ Plus 管（BD，美国），并在 Bactec™ 9000 血培养系统（BD，美国）中连续监测。使用商业鉴定试剂盒，主要是 API 20 A（生物梅里埃，法国），辅以 Vitek ANC 卡（生物梅里埃，法国）和 AN-Ident 圆盘（英国 Oxoid）鉴定厌氧菌。从 2009 年至 2011 年中提取了厌氧菌的代表性亚群，并使用 Etest 法测定了青霉素、阿莫西林-克拉维酸、克林霉素、亚胺培南、莫西沙星、哌拉西林-他唑巴坦和甲硝唑的药敏性。

结果

厌氧菌占所有阳性血培养的 4.1%，10 年间共分离出 727 株需氧菌，阳性率为 0.35%。仅在 2003 年至 2004 年间厌氧菌阳性率发生了显著变化，增加了 0.2%。脆弱拟杆菌群（45%）是主要的厌氧菌病原体，其次是梭菌属（12%）、丙酸杆菌属（11%）和梭杆菌属（6%）。体外最有效的抗生素是亚胺培南、哌拉西林-他唑巴坦、阿莫西林-克拉维酸和甲硝唑，敏感性分别为 95.0%、93.3%、90.8%和 90.8%。对青霉素、克林霉素和莫西沙星的耐药率较高。然而，不同种属之间的抗生素药敏性存在明显差异。