外科重症监护病房细菌流行及耐药现状调查分析

Investigation and analysis about bacteria predominant of surgical intensive care unit and drug resistance

目的:了解外科重症监护病房(SICU)细菌流行及耐药情况,为临床合理使用抗菌药物提供依据。方法:用WHO推荐的WHONET5.4统计软件进行分析。结果:在SICU中感染的细菌以革兰阴性杆菌为主,占60.7%:主要是大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌;革兰阳性球菌占35.7%:以金黄色葡萄球菌、肠球菌以及凝固酶阴性葡萄球菌为主要分离菌;念珠菌占3.7%。大肠埃希菌、肺炎克雷伯菌ESBLs检出率分别为63.3%和48.1%。葡萄球菌MRSA、MRCNS检出率为75.0%和68.9%。E试验表明产ESBLs的大肠埃希菌、肺炎克雷伯菌株对第三、四代头孢菌素、环丙沙星的M IC50较高,且出现2株亚胺培南和美罗培南中介的肺炎克雷伯菌;非产ESBLs菌株对第三代、四代头孢菌素及含酶抑制剂β-内酰胺类抗菌素耐药率均<10%;鲍曼不动杆菌对头孢哌酮/舒巴坦及阿米卡星的敏感率分别是85.3%和76.0%;铜绿假单胞菌对哌拉西林/他唑巴坦的敏感率为87.1%、头孢他啶75.1%、阿米卡星71.7%、头孢哌酮/舒巴坦64.5%;葡萄球菌对万古霉素和替考拉宁敏感率为100%,对其他抗菌药物高度耐药;肠球菌中检出2株耐万古霉素的屎肠球菌。结论:SICU中耐药现象严重,尤其是铜绿假单胞菌和鲍曼不动杆菌对碳青霉烯类抗菌素的耐药以及耐万古霉素肠球菌的流行值得关注。需加强SICU病原菌及耐药性监测,为临床合理使用抗菌药物提供参考依据。

Objective：To investigation and analysis about bacteria rredominant of surgical intensive care unit and drug resistance in order to provide the clinical basis for the rational use of antimicrobial agents.Methods：Analysis by WHONET5.4 statistical software recommended WHO.Results：Bacterial in the SICU is mainly gram-negative bacilli accounted for 60.7%,included Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,Acinetobacter baumannii;Gram-positive cocci accounted for 35.7%,such as the Staphylococcus aureus,Enterococcus,and coagulase-negative staphylococci as the main isolated bacteria;Candida albicans accounted for 3.7%.Escherichia coli,Klebsiella pneumoniae ESBLs detection rates were 63.3% and 48.1%.Staphylococcus aureus MRSA,MRCNS detection rate was 75.0% and 68.9%.E test showed that the MIC of Escherichia coli and Klebsiella pneumoniae strains producing ESBLs of the third and fourth generation cephalosporins,ciprofloxacin is high,and two imipenem and meropenem-mediated Klebsiella pneumoniaes were found;resistance rates of strains producing non-ESBLs to the third generation and fourth generation cephalosporins and inhibitors of β-lactam antimicrobial is 10%;the sensitivity rates of Acinetobacter baumannii to cefoperazone/sulbactam and amikacin were 85.3% and 76.0%;Pseudomonas aeruginosa to piperacillin/tazobactam sensitivity rate of 87.1%,ceftazidime 75.1%,amikacin 71.7%,cefoperazone/sulbactam,64.5%;the sensitivity rate of Staphylococcus aureus to vancomycin and teicoplanin is 100%;two vancomycin-resistant enterococci in feces were detected.Conclusion：The resistance phenomenon in SICU is serious,especially Pseudomonas aeruginosa and Acinetobacter baumannii sp vinyl hydrocarbon resistance were concerned.The monitoring of drug resistance of pathogenic bacteria should be strengthen,which can provide reference of using of antimicrobial agents for clinical rational.