ICU菌血症流行病学及抗菌药物敏感性分析

Epidemiology and Analysis of Sensitivity for Antibiotics of Bacteremia in Intensive Care Unit

目的了解重症监护病房(ICU)3年来菌血症的流行病学及抗菌药物敏感性,为临床防治提供依据。方法收集医院ICU 2005年1月—2007年12月血培养阳性的465例住院患者的临床资料,对菌血症的患病情况及病原菌抗菌药物敏感性进行回顾性分析。结果3年内ICU共送检血培养6481份,阳性1465份,阳性率22.6%,其中真菌155份,占阳性血培养10.6%;同期ICU入院4477例次,符合菌血症的患者465例1056株,其中革兰阳性(G+)菌611株,占57.9%;革兰阴性(G-)菌392株,占37.1%;G+菌以凝固酶阴性葡萄球菌(CNS)为主,占43.0%,金黄色葡萄球菌2.1%,对常用抗菌药物的耐药性测定提示对万古霉素、替考拉宁敏感性相对较高;G-菌中鲍氏不动杆菌8.6%、嗜麦芽寡养单胞菌6.6%、假单胞菌属5.1%、肺炎克雷伯菌5.3%对常用抗菌药物的耐药性测定提示对头孢哌酮/舒巴坦敏感率较高。结论CNS分离率和感染率逐年增加应引起重视,G+菌对万古霉素、替考拉宁敏感性相对较高,G-菌对头孢哌酮/舒巴坦敏感率较高,临床选择抗菌药物时可考虑优先使用;非白色假丝酵母菌所致的假丝酵母菌菌血症有所上升。

OBJECTIVE To study the epidemiology and the sensitivity to antibiotics of bacteremia in intensive care unit, and provide the reference for the clinical antimicrobial agents usage. METHODS 465 cases of bacteremia from Jan 2005 to Dec 2007 in the First Affiliated Hospital, Medical College of Zhejiang University were retrospectively analyzed. RESULTS Totally 1465 strains of pathogens were isolated in three years, and the positive rates were 22.6%. From them 155 strains were fungi（10.6%）, 611 strains were Gram-positive bacteria（57.9%） and 392 strains were Gram-negative bacteria （37. 1%）. G＋ strains mainly included coagulase-negative Staphylococcus （CNS, 43.0%） and Staphylococcus aureus （2. 1%）~ the sensitive antibiotics were vancomycin and teicoplanin. G- strains mainly included Acinetobacter baurnannii （8. 6 %） ; Stenotrophomonas rnaltophilia （ 6. 6 % ） ; Pseudomonas（5. 1%） and Klebsiella pneumoniae （5. 3%）, the sensitive antibiotics were cefoperazone/sulbactam. CONCLUSIONS The positive rates of blood culture are higher in intensive care unit than in others. We should pay more attention to CNS for its high infection rate. The sensitive antibiotics of G＋ are vancomycin and teicoplanin. The sensitive antibiotics of G- are cefoperazone/sulbactum. Antimicrobial therapy should be conducted according to susceptibility test. The candidemia caused by non-Candida albicans （NCA） is increaseing in recent 3 year.