Kozlov A V, Gusyakova O A, Lyamin A V, Kezko J L, Khaliulin A V, Ereshchenko A A
Samara State Medical University, 43099, Samara, Russia.
Klin Lab Diagn. 2018;63(9):574-578. doi: 10.18821/0869-2084-2018-63-9-574-578.
The aim of our research was to evaluate the structure and the determination of the phenotypes of antibiotic resistance of microflora isolated from patients' blood in a multidisciplinary hospital during the period from 2013 to 2017. The material was taken into BacT / ALERT bottles containing nutrient media, followed by incubation of blood. In case of a positive result, the material from the vials was dispersed into dense nutrient media. Species identification was carried out using commercial biochemical API test systems and MALDITOF mass spectrometry. The antibiotic resistance of the isolated microorganisms was evaluated by a classical disc-diffusion method. From 2013 to 2017, 3504 blood tests were performed, of which 16.8% were positive. Of the isolated strains, 69.6% were Gram-positive, 27% were Gram-negative, and 3.4% were fungi. The structure of Gram-positive bacteria included Staphylococcus spp - 71.46%, Enterococcus spp. - 21.22% and Streptococcus spp - 7.32%. Staphylococcus aureus (47,8%) prevailed among staphylococci (in 62.14% were methicillin-resistant) and coagulase-negative staphylococci. Among the genus Enterococcus spp, Enterococcus faecalis prevailed (27% resistant to macrolides, 14% to fluoroquinolones) and Enterococcus faecium (69% resistant to penicillins, fluoroquinolones, macrolides). Streptococcus pneumoniae, Streptococcus pyogenes and streptococci from the group of alpha-greening were isolated from streptococci. Clinically significant types of streptococci in 33.3% were resistant to macrolides and fluoroquinolones. In the structure of gram-negative bacteria, Enterobacteriaceae prevailed - 71.07% (Klebsiella pneumoniae, E. coli); the proportion of non-fermenting Gram-negative bacteria (NFGOB) was 28.93%. Most Gram-negative bacteria were producers of extended-spectrum beta-lactamases (BLBRs). In NFGOB structure allocated Acinetobacter baumanii - 56,5% (81% polyresistant), Pseudomonas aeruginosa - 30,4% (50% - Carbapenemase Producing Organisms), Stenotrophomonas maltophilia - 10,9%. Thus, microbiological research in septic blood conditions is an integral part of the diagnostic search, selection of etiotropic therapy and monitoring of its effectiveness.
我们研究的目的是评估2013年至2017年期间在一家多学科医院从患者血液中分离出的微生物群落的结构及其抗生素耐药表型的测定。将材料放入含有营养培养基的BacT / ALERT瓶中，然后进行血液培养。如果结果为阳性，则将小瓶中的材料分散到致密的营养培养基中。使用商业生化API测试系统和MALDI-TOF质谱进行菌种鉴定。通过经典的纸片扩散法评估分离出的微生物的抗生素耐药性。2013年至2017年期间，共进行了3504次血液检测，其中16.8%呈阳性。在分离出的菌株中，69.6%为革兰氏阳性菌，27%为革兰氏阴性菌，3.4%为真菌。革兰氏阳性菌的结构包括葡萄球菌属 - 71.46%，肠球菌属 - 21.22%，链球菌属 - 7.32%。金黄色葡萄球菌（47.8%）在葡萄球菌中占主导地位（62.14%对甲氧西林耐药）以及凝固酶阴性葡萄球菌。在肠球菌属中，粪肠球菌占主导地位（27%对大环内酯类耐药，14%对氟喹诺酮类耐药）和屎肠球菌（69%对青霉素、氟喹诺酮类、大环内酯类耐药）。肺炎链球菌、化脓性链球菌和α-溶血组链球菌被分离出来。临床上有意义的链球菌类型中，33.3%对大环内酯类和氟喹诺酮类耐药。在革兰氏阴性菌的结构中，肠杆菌科占主导地位 - 71.07%（肺炎克雷伯菌、大肠杆菌）；非发酵革兰氏阴性菌（NFGOB）的比例为28.93%。大多数革兰氏阴性菌是超广谱β-内酰胺酶（BLBRs）的产生菌。在NFGOB结构中，鲍曼不动杆菌占56.5%（81%多重耐药），铜绿假单胞菌占30.4%（50% - 产碳青霉烯酶菌株），嗜麦芽窄食单胞菌占10.9%。因此，败血症血液状况下的微生物学研究是诊断搜索、选择病因治疗及其有效性监测的一个组成部分。
