重症医学科常见病原菌分布及其耐药性分析

Analysis of the distribution and antibiotic resistance of common pathogenic bacteria from ICU

目的探讨重症医学科(ICU)分离细菌菌株及细菌耐药情况,为重症医学科临床防治工作提供一定的参考依据。方法对2008年5月—2009年5月我院ICU所分离的细菌菌株、真菌及细菌耐药性进行回顾性分析。结果全年共分离获得菌株322株,分离菌仍以革兰阴性杆菌为主,有227株,占70.50%,主要为铜绿假单胞菌(25.6%)、鲍曼不动杆菌(14.91%),其次为大肠埃希菌、肺炎克雷伯菌、嗜麦芽假单胞菌;革兰阳性球菌有50株,占15.53%,主要为金黄色葡萄球菌(4.9%),其次分别为溶血性葡萄球菌、屎肠球菌和其他凝固酶阴性葡萄球菌;真菌有45株,占13.98%.体外药敏试验显示:革兰阴性杆菌呈多重耐药特性;嗜麦芽假单胞菌对亚胺培南/西司他丁、美罗培南天然耐药;万古霉素对金黄色葡萄球菌及表皮葡萄球菌均有很强抗菌活性,敏感性均达到100%,但屎肠球菌出现耐药菌株。结论我院重症医学科近1年来分离菌以革兰阴性杆菌为主,各种细菌呈多重耐药特性,应予以高度重视,临床工作中应注意合理使用抗生素,减少耐药菌的产生。

Objective To discuss the spectrum of bacteriums and drugs resistance in intensive care unit （ICU） and provide the evidence for treatment. Methods The bacteriums isolated from ICU and their drugs resistance were retrospectively analyzed from May 2008 to May 2009. Results There were 322 bacteriums isolated from ICU one year. Gram-negative bacteria （G^-,70.50%） was still the main isolates in ICU, followed byGram-positive bacteria （G^＋, 15.53% ）.Gram-negative bacteria wen pyocyaneum bacterium, Acinetobacter, colibaciUus, Klebsiella pneumoniae and Pseudomonas maltophilia.Gram-positive bacteria wen Staphylococcus aureus, streptococcus, enterococci, coagulase and nega-tive staphylococcus.Fungi wen 19.2%.The drugs susceptibility test in vitro showed that the main Gram-negative bacteria were all in multi drug resistance. Pseudomonas maltophilia were resistant against Imipenem and Meropenem obviously. Vancomycin have strong antibacterial activity against Staphylococcus Aureus and Staphlococcus epidermidis, But there emerged drug-resistant strains of Enterococcus. Conclusion The Gram-negative bacteria is still the most prevalence isolates in ICU.Many bacteriums are all in muhidrug resistance. So it＇s important to use these medicince rationally in clinic.