ICU病房病原菌的分布及其耐药性分析

Surveillances of pathogens distribution and antibiotic resistance in general intensive care unit

目的探讨综合性重症监护病房(ICU)中感染的病原菌分布及其耐药情况,为临床经验性选择抗生素提供必要的细菌学依据。方法收集2004年7月～2004年12月入住ICU患者的痰、血、尿、中心静脉穿刺针顶端及局部引流物进行细菌学培养及药物敏感性试验。结果102例患者中73例发生感染,共分离出菌株141株,其中产ESBL菌株18株。感染部位最多为下呼吸道,其次泌尿系。下呼吸道中最常见病原菌为铜绿假单胞菌、表皮葡萄球菌;泌尿系中常见病原菌为真菌,其次为大肠杆菌。在141株细菌中,G-杆菌占39.7%,G+菌占37.6%,真菌占22.7%。亚胺培南对G-杆菌的敏感性较好,万古霉素对G+球菌的敏感性较好,未发现耐万古霉素的肠球菌及葡萄菌产生。结论ICU内感染的病原菌主要存在于下呼吸道,病原菌以G-杆菌为主,病原菌显示多重耐药。亚胺培南对G-杆菌敏感性较好,而万古霉素对G+菌有较高的敏感性。

[Objective] To investigate the distribution of pathogens and their antibiotic resistance in general intensive care unit. [Methods] Pathogens isolated in sputum, blood, urine, cent ral venous catheter and local drain from patient s admitted were collected and analyzed during July 2004 to December 2004. [Results] A total of 141 pathogens were identified, pathogens were isolated from at least one location in 73 cases out of 102 patients. The number of ESBL strains were 18. The most common sites of infection were lower respiratory tract, followed by uri- nary tract. Pseudomonas aeruginosa and Staphlococcus epidermidis were common strains in respiratory tract; Fungi and Escherichia coli were common in urinary tract. Among 141 strains, 39.7 % were Gram - negative bacteria, 37.6% were Gram positive cocci and 22.7% were fungi. Most of Gram negative bacteria were sensitive to Imipenem, and most of Gram positive bacteria were sensitive to Vancomycin. [Conclusions] Lower respiratory tract is the major infection site in intensive care unit, Gram - negative bacilli are the most common pathogens, which present with multi - drug resistant pattern. Most of Gram negative bacteria are sensitive to Imipenem, Vancomycin is active against Gram positive cocci.