重症监护病房患者细菌感染分布与耐药性分析

Analysis of distribution and antimicrobial resistance of clinical bacteria in Intensive Care Unit(ICU)

目的了解院重症监护中心(ICU)细菌检出率、分布及耐药特点,为临床治疗和合理使用抗生素提供依据。方法用VITEK32全自动微生物分析仪鉴定细菌,用纸片扩散法(K-B法)对常用抗菌药物进行耐药性测定。结果在254份检出细菌阳性标本中共培养出287株细菌,其中革兰阴性杆菌225株(78.4%),革兰阳性球菌41株(14.3%),念珠菌21株(7.3%),检出菌来自呼吸道标本占63.4%,其他标本各占5%左右;细菌检出占构成比前三位的依次为铜绿假单胞菌19.5%、肺炎克雷伯菌16.7%、大肠埃希菌14.3%;耐甲氧西林金黄色葡萄球菌、耐甲氧西林凝固酶阴性葡萄球菌和耐万古霉素的肠球菌的发生率分别为88.2%、70.0%和11.1%;大肠埃希菌和肺炎克雷伯菌的超广谱β-内酰胺酶(ESBLs)的检出率分别为68.6%和65.2%,铜绿假单胞菌对亚胺培南的耐药率为40.2%;白色念珠菌对氟康唑的耐药率为81.3%,对两性霉素的耐药率为3.2%。结论ICU病房革兰阴性杆菌感染仍占主导地位,革兰阴性杆菌对氨苄西林耐药率最高,对亚胺培南耐药率最低(嗜麦牙窄食单胞菌除外),产ESBLS多重耐药;革兰阳性球菌对阿齐霉素耐药率最高,对万古霉素耐药率最低。

Objective To investigate the bacterial distribution and the extent of drug resistance in Intensive Care Nnit（ICU） patients and offer information for the guidance of reasonably use of antibiotics. Methods Bacterium were be identified by VITEK - 32 system, Disc diffusion test （K- B method） was used to study the antimicriobial resistance. Results Totally 287 strains were isolated from the 256 positive samples , and the gram - negative bacilli were 225（78.4%, ）, The gram - positive coccus were 41 （14.3%）, snd the monilia were 21 （7.3%）.The distributions of clinical bacteria were respiratory tract （63.4%）, urinaryract （7.0%） ,secretion（includingwound .3% ） ,blood（5.9% ） ,stool（5.2% ） , pucture fluid（4.9% ）, and other sites（7.3% ）, Of all isolating bacterium, from the first to the fifth were Ps. aeruginosa （ 19.5 % ）, K. pneumoniae （ 16.7 % ）, E. coli（ 14.3 % ）, A. baumannii （ 11.8 % ） and Psemal （ 10.1% ） . Resistant rates of Methecillin - resistant S. anreus （MRSA）, Methecillin - resistant coagulase - negative staphylococci（MRCNS） and Vancomycin- resistant （VRE）were 88.2% ,70.0% and 11.1% respectively;The incidence of E.coli and K. penumoniae produce extended speutrum beta- lactamase were 68.6% 和 65.2%, 44.6% of Ps.aeruginosa isolates were resistant to Imipenem; The highest examining rate of 21 kinds of Monilia was Candida albicans （66.7%）, Resistant rate of Candida albicans to Fluconazole and Amphotricin B was 51.3% and 1.3% . Conclusion Gram- negative bacilli were predominant in ICU patients, Gram- negative bacilli were the highest resistance to Ampicillin, whereas were the lowest resistance to Imipenem（ except Xanthmonas maltophifia）The gram- positive coccus were the highest resistance to Axithromyein, whereas were the lowest resistance to Vaneomycin;; MRSA, MRCNS, VRE and ESBLS were multidrug resistant; Resistant rate of candida was the highest to Fluconazole, and the lowest to Amphotricin B.