神经外科加强医疗病房的细菌耐药性监测

Nosocomial Bacterial Infection in Neurosurgical Intensive Care Unit

目的 了解神经外科加强医疗病房 (NSICU)医院获得性细菌感染的病原菌及耐药情况。方法 持续监测和总结北京天坛医院NSICU 1998～ 2 0 0 3年 9月所有细菌分离株及其耐药。结果 细菌总数 5 0 9株 ,革兰阳性(G+ )菌比例平均 4 5 % ,G+ 菌中 ,葡萄球菌属占 96 % ,耐甲氧西林金黄色葡萄球菌 (MRSA)占金黄色葡萄球菌的82 % ,耐甲氧西林凝固酶阴性葡萄球菌 (MRSCON)占凝固酶阴性葡萄球菌近 10 0 % ;革兰阴性 (G-)菌中 ,铜绿假单胞菌、不动杆菌属、嗜麦芽寡养单胞菌、肺炎克雷伯菌、肠杆菌属和大肠埃希菌分别占 2 8%、2 6 %、10 %、8%、6 %和 4 % ;亚胺培南、阿米卡星、头孢他啶、环丙沙星、妥布霉素对G-菌的敏感率分别为 6 5 %、4 8%、4 6 %、4 4 %、4 1% ;万古霉素对MRSA、MRSCON及肠球菌属的敏感率分别是 10 0 %。结论 NSICU中以肺部感染为主 ,金黄色葡萄球菌、铜绿假单胞菌、不动杆菌属多见且耐药严重 ;建立本单位医院感染病原菌常规监测制度是必要的 ;

OBJECTIVE To establish the prevalence of nosocomial bacterial infection and changes in resistance in a neurosurgical intensive care unit (NSICU). METHODS The species and resistance pattern of bacterial isolates in NSICU of Tiantan Hospital from 1998 to Sept 2003 were analyzed retrospectively. RESULTS Among all bacterial isolates (n=509), the percentage of Gram positive cocci was 45%. Meticillin resistant Staphylococcus aureus and Meticillin resistant coagulase negative Staphylococcus accounted for 82% and 100% of Gram positive pathogens, respectively. The respective percentage of Pseudomonas aeruginosa, Acinetobacter, Stenotrophomonas maltophilia, Klebsiella pneumoniae, Enterococcus and Echerichia coli accounted for 28%, 26%, 10%,8%,6% and 4% of Gram negative bacilli, The susceptive rate of Gram negative bacteria to imipenem, amikacin, ceftazidime, ciprofloxacin and tobramycin were 65%, 48%, 46%, 44% and 41%, respectively. The susceptive rate of Meticillin resistant S. aureus, Meticillin resistant coagulase negative Staphylococcus and Enterococcus to vancomycin were all 100%. CONCLUSIONS The main nosocomial bacterial infection in NSICU is pulmonary infection. Prevailing pathogens were Staphylococcus, Pseudomonas and Acinetobacter, and represented severe resistance. Understanding of the epidemiological data and changes in bacterial resistance profile is prerequisite to rational use of antibiotics.