重症监护病房病原菌分布与耐药性分析

Distribution and Drug Resistance of Pathogenic Bacteria in Intensive Care Unit

目的分析重症监护病房(ICU)常见病原菌的分布及其耐药性,为临床治疗提供参考。方法对2006年7月-2009年6月ICU患者送检的标本进行培养,用VITEK细菌鉴定及药敏分析系统对菌落进行菌种鉴定及药敏分析,对检出菌株的构成、标本间的分布及药敏结果进行分析。结果共分离出664株病原菌,其中革兰阴性杆菌56.2%、革兰阳性球菌18.2%、真菌25.6%;革兰阴性杆菌中,非发酵菌以鲍氏不动杆菌(14.6%)、铜绿假单胞菌(14.3%)、洋葱伯克霍尔德菌(5.6%)及嗜麦芽寡养单胞菌(5.3%)为主,而肠杆菌科细菌则以大肠埃希菌(8.1%)、肺炎克雷伯菌(5.1%)及阴沟肠杆菌(2.0%)为主,革兰阳性球菌以凝固酶阴性葡萄球菌(10.5%)为主,真菌以白色假丝酵母菌(16.7%)为主;在检出有病原菌的标本中,前3位依次为痰液(72.0%)、血液(10.7%)、引流液(7.5%);细菌耐药性结果表明,肠杆菌科细菌对美罗培南、亚胺培南的耐药率≤5.9%,大肠埃希菌及肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)阳性率分别为72.2%、50.0%,产酶菌的耐药率普遍高于非产酶菌,β-内酰胺酶抑制剂对产酶菌及非产酶菌的抑菌效果都很明显;阴沟肠杆菌对美罗培南、亚胺培南以外抗菌药物的耐药率为0。结论革兰阴性杆菌是ICU患者主要病原菌,主要发生呼吸道感染,非产酶菌对抗菌药物的敏感性好,其余细菌均具有医院感染菌的特点,敏感抗菌药物谱窄,细菌的耐药性严重;真菌对药物的敏感性好。

OBJECTIVE To analyze the clinical distribution and the drug resistance of pathogenic bacteria in the intensive care unit（ICU） and to provide the evidence for clinical therapy.METHODS Bacterial culture of all samples in ICU from Jul 2006 to Jun 2009 was done.The species identification and drug sensitivity tests were performed using VITEK automatic systems,then the proportion of the strains and the distribution among the specimens and the results of sensitivity to antibiotics were analyzed.RESULTS A total of 664 pathogens were isolated,which included 56.2% Gram-negative bacteria,18.2% Gram-positive cocci and 25.6% fungi.Among the Gram-negative bacteria,the main pathogenic bacteria from non-fermenters in turn were Acinetobacter baumannii（14.6%）,Pseudomonas aeruginosa（14.3%）,Burkholderia cepacia（5.6%） and Stenotrophomonas maltophilia（5.3%）;however,the main pathogenic bacteria from Enterobacteriaceae in turn were Escherichia coli（8.1%）,Klebsiella pneumoniae（5.1%） and Enterobacter cloacae（2.0%）,respectively.Among the Gram-positive cocci,the main pathogenic bacteria were the coagulase-negative staphylococci（10.5%）,and the main fungus was Candida albicans（16.7%）.Among all of the positive specimens,the three most common ones were in turn the sputum（72.0%）,the blood（10.7%）and the drainage fluid（7.5%）,respectively.The results of the bacterial resistance showed the sensitive rate of Enterobacteriaceae to either meropenem or imipenem was less than 5.9%,and the extended-spectrum β-lactamases（ESBLs） producing E.coli and K.pneumoniae strains occupied 72.2% and 50.0%,respectively.The drug resistance rates of ESBLs producers were commonly much higher than that of nonproducers.The inhibiting effect of the antibiotics containing β-lactamases inhibitor was obvious to either ESBLs producers or nonproducers.The resistance rates of E.cloacae to the other antibiotics except meropenem and imipenem were 69.2-100%.CONCLUSION Gram-negative bacteria are the major pathogens isolated from ICU,and they mainly induce the lower respiratory tract infection.The antibiotics have higher sensitivity and antibacterial activity for ESBLs nonproducers,but they have less sensitivity and antibacterial activity for the other strains which own the character of hospital infection strains.The drugs have high sensitivity to fungi.