重症监护病房416株革兰阳性菌耐药状况分析

Analysis of drug resistance status of 416 Gram-positive strains isolated from intensive care unit

目的:了解重症监护病房(intensive care unit,ICU)革兰阳性(G+)菌的分布及其耐药性,为临床合理用药提供参考。方法:收集来自ICU各类标本分离的G+菌,用VITEKAMS-60或VITEK-Ⅱ全自动微生物分析仪进行菌种鉴定,按美国2008年临床和实验标准化研究所(Clinical and Laboratory Standard Institute,CLSI)制定指导原则中的K-B法进行药物敏感试验及结果判断。结果:从ICU中检出的416株G+菌以凝固酶阴性葡萄球菌为主,有216株(51.9%)。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)检出率分别占该两类葡萄球菌的80.9%和95.4%。肠球菌呈多重耐药状态。替考拉宁和万古霉素对临床分离的G+菌均显示强大的抗菌活性,未检出耐药菌株。结论:来自ICU的G+菌呈现多重耐药性,临床医师和药师应重视耐药监控,预防耐药菌株的产生及流行。

Objective：To investigate the drug resistance status and distribution of Gram-positive（G＋） bacteria strains in intensive care unit（ICU）,in order to provide evidence for rational use of antibiotics in clinic.Methods：G＋ bacteria strains were isolated from all kinds of specimens in ICU.Strains were identified with VITEK AMS-60 or VITEK Ⅱautomatic microbiology analyzer and the drug sensitivity test were performed using K-B method of guidelines formulated by 2008 America Clinical and Laboratory Standards Institute（CLSI）.Results：Among the 416 G＋ bacteria strains isolated from ICU,the coagulase-negative Staphylococcus ranked the top,accounting for 216 strains （51.9%）.The detection rate of meticillin-resistant Staphylococcus aureus （MRSA） was 80.9% and that of meticillin-resistant coagulase-negative Staphylococcus （MRCNS） was 95.4% in the 2 kinds of Staphylococcus.Enterococci had multiple drug resistance.Both teicoplanin and vancomycin were the most active agents against G＋ bacteria isolated.No strains resistant to teicoplanin and vancomycin were found.Conclusion：G＋ bacteria strains isolated from ICU have high multiple drug resistance.Clinical physicians and pharmacists should pay attention to supervising the drug-resistance of G＋ bacteria and prevent the occurrence and epidemic of drug resistant strains.