心脏外科重症监护病房革兰阳性球菌医院感染状况及耐药性分析

Distribution and Antibiotics Resistance of Nosocomial Gram-positive Cocci Infection in Intensive Care Unit of Cardiac Surgery

目的调查医院心脏外科重症监护病房（ICU）革兰阳性球菌医院感染状况与耐药性。方法分析2005年1月～2008年12月ICU医院感染患者各种标本所分离的革兰阳性球菌，采用VITEK—Jr全自动细菌鉴定及药敏分析系统鉴定细菌类别，纸片扩散（K—B）法进行药敏试验，应用WHONET5．4进行数据分析。结果共分离革兰阳性球菌164株，其中葡萄球菌属133株，肠球菌属24株，链球菌属7株；呼吸道感染82例（50．0％），血液感染33例（20．1％），其他部位感染49例（29．9％）；前3位致病菌为表皮葡萄球菌50株（30．5％），溶血葡萄球菌25株（15．2％），金黄色葡萄球菌23株（14．0％）；耐甲氧西林的金黄色葡萄球菌（MRSA）和凝固酶阴性葡萄球菌（MRCNS）分别为65．2％和97．2％，葡萄球菌属对常用抗菌药物耐药严重，未发现对耐万古霉素葡萄球菌及粪肠球菌和屎肠球菌。结论革兰阳性球菌是ICU医院感染的重要病原菌，且有增加趋势，万古霉素保持良好的抗菌活性。

OBJECTIVE To investigate the clinical distribution and antibiotics resistance of nosocomial Grampositive cocci infection in ICU of cardiac surgery. METHODS The clinical data of postoperative patients with microbiologically documented nosocomial infection from Jan 2005 to Dec 2008 were retrospectively analyzed. Bacterial identification was performed in an automatic VITEK-Jr Expression system and antimicrobial susceptibility testing by Kirby-Bauer method. The results were analyzed by WHONETS. 4. RESULTS There were 164 Gram-positive cocci clinical isolates including 133 Staphylococcus strains,24 Enterococcus strains and 7 Streptococcus strains. Eighty-two （50%） of the positive cultures were isolated from the lower respiratory tract while 33 （20.1%） from the bloodstream and 49（29.9 %） from other samples. S. epidermidis（50strains,30.5 %）, S. haemolyticus（25 strains, 15. 2%）and S. aureus（23 strains, 14%）were the predominant Gram-positive cocci. The detection of meticillin-resistant Staphylococcus （MRS） were 65.2% in S. aureus and 97.2% in coagulase negative Staphylococcus. Bacterial resistance rate of Staphylococcus to the most antibiotics was much higher. There was no Staphylococcus,Enterococcus faecalis and E. faecium strains resistant to vancomycin. CONCLUSIONS Grampositive cocci are the important pathogens in ICU and the incidence is increasing gradually. Vancomyein is the most active antibiotic to Gram-positive cocci clinical isolates.