神经外科重症监护病房常见病原菌的分布与耐药性研究

Study on the distribution of common pathogens and their antibiotic resistance in a neurosurgery intensive care unit

目的调查珠江医院神经外科重症监护病房(ICU)病原菌的分布与耐药情况,分析ICU院内感染的发生原因,探讨防治对策。方法应用法国VITEKⅡ全自动细菌鉴定仪鉴定病原菌,用纸片扩散法检测药敏结果。结果神经外科ICU菌群主要以革兰阴性杆菌(71.6%)为主,鲍曼不动杆菌占16.7%,大肠埃希菌占15.7%,铜绿假单胞菌占13.7%,肺炎克雷伯菌占13.7%等。但葡萄球菌、粪肠球菌等阳性球菌(28.4%)也有增加的趋势。亚胺培南和头孢哌酮/舒巴坦仍保持最高抗菌活性,细菌的耐药率分别为15.3%和30.6%。结论我院神经外科ICU感染主要病原菌是革兰阴性杆菌,对常用抗菌药物耐药性较高,但革兰阳性球菌所占比例呈增高趋势。控制第二、三代头孢菌素以及制酸剂(质子泵抑制剂)的预防性用药,减少耐药菌株的产生,有针对性地使用抗生素是控制危重病人感染的有效措施。

Objective To investigate the distribution of common pathogens and their antibiotic resistance from patients in neurosurgery intensive care unit （ICU） of zhujiang hospital and to explore the preventive strategies against hospital onset of infection. Methods The France VITEK Ⅱ automatic bacterial identification instrument was used to appraise pathogens. The susceptibility to antimicrobial agents was studied with diffusion method on mueller hinton medium. Results Gram negative bacilli are the most common pathogens in the neurosurgery ICU. Pathogens included Acinetobacter baumannii （16.7%）, E. coli （15.7%）, Pseudomonas aeruginosa （13.7%） and Klebsiella pneumoniae （13.7%）. But gram positive cocci （28.4%） such as staphylococci and E. faecalis were also seen increasing. The resistance rates to cefoperazone/sulbactam and imipenem were the lowest, being 15.3% and 30.6%. Conclusion Bacterial resistance rates in our neurosurgery ICU are high. Gram negative bacilli are the most common pathogens. The control of the prophylactic cephalothin and antacid （proton pump inhibitor）, the decrease of the production of drug resistant strain and the reasonable use of antibiotices are the effective measures of reducing the respiratory tract infections.