摘要
目的了解我院重症监护病房(ICU)引起医院感染病原菌类型、分布及对抗菌药物耐药状况,以指导医院感染病原菌的耐药性监测和临床合理使用抗生素。方法使用全自动微生物分析系统(VITEK、Phoenix100)对2007年1月至2008年12月8个ICU病房送检的临床标本中病原菌进行鉴定和药敏试验,并运用WHONET软件对检测结果进行统计分析。结果送检标本5765份,分离菌株3511株,细菌检出率为60.9%,其中革兰阴性杆菌2052株(58.4%),革兰阳性球菌938株(26.7%),真菌521株(14.8%)。革兰阴性杆菌前五位分别是大肠埃希菌、鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌和阴沟肠杆菌。大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶(ESBL)菌株阳性率分别为59%和54%,鲍曼不动杆菌中泛耐药鲍曼不动杆菌占57%。革兰阳性球菌以金黄色葡萄球菌为主(389株,41.5%),其次为溶血葡萄球菌、表皮葡萄球菌、其它凝固酶阴性葡萄球菌和肠球菌(58株6.1%)。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)比例分别为77%、89%。耐万古霉素肠球菌7%。大肠埃希菌和肺炎克雷伯菌对氨苄西林、氨曲南、头孢匹肟和头孢他啶的敏感率均低于40%,对亚胺培南的敏感率高于90%;鲍曼不动杆菌和铜绿假单胞菌除对多粘菌素高度敏感外,对阿米卡星、亚胺培南、庆大霉素和头孢菌素均产生不同程度的耐药性;阴沟肠杆菌对亚胺培南和阿米卡星的敏感率高于80%,对左氧氟沙星、头孢匹和头孢他啶的敏感率低于60%;革兰氏阳性球菌对万古霉素的敏感率为90%~100%,对链阳霉素、利福平和呋喃妥因产生不同程度耐药性。真菌以白色念珠菌为主,对5-氟胞嘧啶、氟康唑、伊曲康唑、伏立康唑和两性霉素B的敏感率高于90%。结论ICU病房病原菌检出率高,且常为条件致病菌和多重耐药菌,耐抗菌药物种类广,耐药性强。
Objective To investigate the type,distribution and drug resistance of bacteria causing nosocomial infection in the 8 Intensive Care Units (ICU) of Sichuan provincial people's hospital from Jan. 2007 to Dec. 2008,and to provide guidance for monitoring drug resistance of nosocomial infection pathogens and rational use of antibiotics. Methods VITEK and Phoenix 100 were applied to identify bacteria from samples of ICU and perform drug sensitivity test. The data were analyzed by WHONET software. Results 3511 strains were separated from 5765 samples with the positive rate of 60.9%,including 2052 gram-negative bacteria,938 gram-positive bacteria and 521 fungi. The first five gram-negative bacteria were E. coli,A. baumanmii,K. pneumoniae,P. aeruginosa and E. cloacae. The positive rate of E. coli and K. pneumoniae producing extended-spectrum-β-lactamases(ESBL) were 59% and 54%. And the positive rate of pan-drug-resistant A. baumanmii was 57%. S. aureus was the main gram-positive cocci (389 stains,41.5%),then for S. haemolyticus,S. epidermidis,other coagulase negative staphylococcus and enterococcus. The rate of Methicillin-Resistant S. aureus (MRSA) and meticillin-resistant coagulase negative Staphylococcus (MRCNS) were 77% and 89%. And 7% Enterococci were vancomycin-resistant. The sensitivity of E. coli and K. pneumoniae to ampicillin,aztreonam,cefepime,ceftazidime were all lower than 40%,while higher than 90% to imipenem. A. baumanmii and P. aeruginosa were resistant to amikacin,imipenem,gentamicin,cephalosporin in different degrees besides polymyxin. The sensitivity of E.cloacae to imipenem and amikacin were higher than 80%,but lower than 60% to levofloxacin,cefepime and ceftazidime. The sensitivity of gram-positive cocci to vancocin reached 90~100%,while resistant to streptomycin,rifampicine and furadantin to some extent. C. albicans was the main fungus with the sensitivity over 90% to 5-flurocytosine,fluconazol,itraconazole,voriconazole and amphotericin B. Conclusions The bacteria isolation rate in ICU was high,and most of them were conditional pathogenic bacteria and multi-drug resistant bacteria.
出处
《实用医院临床杂志》
2010年第1期72-76,共5页
Practical Journal of Clinical Medicine