重症监护病房细菌感染连续监测和分析

Surveillance for Bacterial Infections in Intensive Care Units

目的监测近年来医院中心重症监护病房(ICU)各种较常见的细菌感染的发生情况和耐药变迁。方法从2002年7月～2004年12月我院中心重症监护病房分离到的细菌,以美国CLSI/NCCLS文件为执行标准,采用K-B法作体外药敏分析。结果共分离临床细菌647株,革兰阴性杆菌占56.9%(368/647),革兰阳性菌占34.0%(220/647),非发酵菌占革兰阴性杆菌的71.4%(263/368)。最常见的细菌有凝固酶阴性葡萄球菌、金黄色葡萄球菌、黄杆菌属、铜绿假单胞等。大肠埃希菌和肺炎克雷伯菌分离率有下降趋势,占革兰阴性杆菌的10.0%(35/368)和8.0%(30/368),产超广谱!内酰胺酶的大肠埃希菌占56.0%,肺炎克雷伯菌占77.0%。肠杆菌科细菌对亚胺培南耐药率最低;铜绿假单胞菌对亚胺培南耐药率为54.4%。结论ICU病房革兰阴性杆菌仍为主要病原菌,非发酵菌感染已成为较常见病原菌,多重耐药现象严重。强调根据药敏试验结果合理使用抗生素和控制感染。

Objective To investigate the occurrence of bacterial infection and the drug-resistant bacteria in intensive care units. Method Susceptibility of bacterial isolates to antibiotics was determined by Kirby-Bauer method according to the guidelines of CLSI/NCCLS. The isolates were obtained between July 2002 and Dec 2004. Result A total of 647 isolates were examined. 56.9% isolates were Gram-negatlve bacilli and 34% isolates were Gram-positive cocci. 71.4% （263/368） isolates were non-fermentative Gram-negative bacilli. The most common bacetrial isolates were coagulase negative Staphylococci, S. aureus, Chryseobocterium spp, and Pseudomonos aeruginosa. Conclusion Gram-negative bacilli were of the major type of bacteria isolated in ICU. Non-fermentative many of the isolates were imultiple-drug resistant strains. The control will rely on the results of antibiotic susceptibility test.