1373株重症监护病房患者分离细菌的分布及耐药性分析

Distribution and drug resistance analysis of 1373 bacterial isolates from intensive care unit patients

目的了解重症监护病房(ICU)患者感染细菌的分布特征及耐药性。方法收集2020年至2022年吉林大学中日联谊医院ICU患者分离的1373株细菌,使用WHONET5.6软件,分析细菌的分布特征及其对抗菌药物的耐药情况。结果在所分离的1373株细菌中以革兰阴性菌为主,共827株(60.2%),主要包括肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌及大肠埃希菌。革兰阳性菌546株(39.8%),主要以屎肠球菌及表皮葡萄球菌为主。标本来源以呼吸道(40.9%)、血液(28.3%)和尿(11.8%)占比最高。肺炎克雷伯菌对黏菌素和替加环素最为敏感,对头孢他啶及头孢吡肟的耐药率均在25%左右。大肠埃希菌对碳青霉烯类药物、阿米卡星及替加环素的耐药率保持较低水平。鲍曼不动杆菌对多种抗菌药物的耐药率均偏高,对亚胺培南及美罗培南的耐药率超过了85%。铜绿假单胞菌对碳青霉烯类药物及喹诺酮类药物的耐药率近3年有一定程度的上升。屎肠球菌及表皮葡萄球菌各发现1株利奈唑胺的耐药菌。结论革兰阴性菌是吉林大学中日联谊医院ICU患者分离的主要细菌,且各类细菌在不同年份的耐药性略有不同,需在合理使用抗菌药物的同时加强对ICU分离细菌的检测及医院内感染的防控,避免耐药菌的传播以及细菌耐药性的上升。

Objective To understand the distribution characteristics and drug resistance of bacteria infecting patients in intensive care unit(ICU).Methods 1373 bacterial strains isolated from ICU patients at the China-Japan Friendship Hospital of Jilin University from 2020 to 2022 were collected,and the distribution characteristics of the bacteria and their resistance to antimicrobial drugs were analysed using WHONET 5.6 software.Results Gram-negative bacteria predominated among the 1373 bacteria isolated,with a total of 827 strains(60.2%),mainly including Klebsiella pneumoniae,Acinetobacter baumannii,Pseudomonas aeruginosa and Escherichia coli.Gram-positive bacteria were 546 strains(39.8%),mainly Enterococcus faecalis and Staphylococcus epidermidis.The highest percentage of specimens came from the respiratory tract(40.9%),blood(28.3%)and urine(11.8%).Klebsiella pneumoniae was most sensitive to mucins and tigecycline,with resistance to ceftazidime and cefepime both around 25%.The resistance rate of Escherichia coli to carbapenems,amikacin and tigecycline remained low.The resistance rate of A.baumannii to various antimicrobial drugs was high,and the resistance rate to imipenem and meropenem was more than 85%.The resistance rate of Pseudomonas aeruginosa to carbapenems and quinolones has increased to a certain extent in the past three years.One strain each of Enterococcus faecalis and Staphylococcus epidermidis was found to be resistant to linezolid.Conclusion Gram-negative bacteria are the main bacteria isolated from ICU patients in our hospital,and the drug resistance of each type of bacteria is slightly different in different years.It is necessary to strengthen the detection of bacteria isolated from ICU and the prevention and control of hospital-acquired infections in addition to the rational use of antimicrobial drugs,so as to avoid the dissemination of drug-resistant bacteria and the rise of bacterial drug resistance.