ICU病区院内感染病原菌及其耐药性分析

Distribution of Pathogenic Bacteria of Hospital Infection in ICU and Drug Resistance Analysis

【目的】探讨ICU病区院内感染病原菌及其耐药情况，为建立有效预防ICU院内感染的对策提供依据。【方法】对本院ICU病区2008年1月至2008年12月院内感染病原菌及其耐药性进行回顾性分析。【结果】①本院ICU院内感染病原菌以G^-杆菌为主（63．3％），其次分别为G^＋球菌（18．5％）与真菌（18．2％），其中排前三位的依次是铜绿假单胞菌（27．1％）、不动杆菌（22．3％）、金黄色葡萄球菌（11．6％）；②耐药特点：细菌耐药性严重，真菌耐药性较轻。铜绿假单胞菌对头孢他啶、头孢吡肟、哌拉西林／他唑巴坦耐药率高达86．5％，74．8％和63．6％，对阿米卡星、亚胺培南的敏感率为62．6％和58．9％；不动杆菌对三、四代头孢菌素耐药率高，对阿米卡星、亚胺培南、头孢哌酮／舒巴坦的耐药率为56．8％，25．0％和25．0％；总耐药率最低的是亚胺培南（26．0％），其对克雷伯菌及大肠埃希菌均保持较好的敏感性；耐甲氧西林金黄色葡萄球菌多重耐药严重，但尚未发现对万古霉素耐药菌株。【结论】ICU院内感染病原菌以G^-杆菌为主；细菌耐药严重。应加强ICU院内感染的病原学检测和监控，严格掌握抗生素使用原则，避免使用能诱导或加重病原菌产生耐药性的药物．

[Objective]To investigate the distribution and drug susceptibility of hospital infection bacteria in a newly rebuilt ICU unit, and to provide the references for drug selection in order to establish effective countermeasures against hospital infection in ICU. [Methods]All the pathogens isolated from patients of hospital infection from January 2008 to December 2008 were analyzed retrospectively. [Results]The most common pathogens were gram-negative bacilli （63. 3%）, followed by gram-positive cocci （18. 5%） and fungi （18.2 %）. And the three most common bacteria were Pseudomonas aeruginosa （27.1%）, Acinetobacter spp. （22.3 %） and Staphylococcus aureus （11.6 %）, respectively. The antimicrobial status of bacteria was severe while that of fungi was relatively gentle. The resistant rates of Pseudomonas aeruginosa to ceftazidime, cefepime and piperacillin/tazobactam were 86. 5%, 74. 8% and 63. 6%, respectively, and the susceptibility rates of it to amikacin and imipenem were 62.6% and 58.9%, respectively. Acinetobacter spp. was resistant to the third and forth generations of cephalosporin widely, and the resistant rates to amikacin, imipenem and cefoperazone/sulbactam were 56.8%, 25.0% and 25.0%, respectively. The resistant rate of imipenem was the lowest （26.0%）, which remained highly active against Klebsiella spp. and Escherichia coli. Multidrug re sistance was severe in MRSA, but none of vancomycin resistant Staphylococcus aureus was found. [Conclusion]Gram-negative bacilli are the most common hospital infection bacteria in ICU. The bacilli show wide resistance to drugs. It is essential to detect and monitor the local distribution and resistant rate of bacilli in ICU, and to adjust drugs timely according to pathogens and drug susceptibility, and to strengthen appropriate use of antibiotics and avoid the usage of drugs which can induce or aggravate resistance.