重症监护病房病原菌分布及耐药性监测

Distribution of Pathogens in ICU and Surveillance of Antibiotic Resistance

目的研究医院2009年重症监护病房(ICU)患者病原菌分布及耐药性的特征。方法对医院2009年ICU分离病原菌进行回顾性分析,采用K-B法和CLSI标准(2007版)判断病原菌耐药性。结果分离出的200株病原菌中以革兰阴性杆菌为主,占63.0%,其次为革兰阳性球菌24.5%、真菌12.5%;革兰阴性杆菌中非发酵菌占主要地位,以铜绿假单胞菌和鲍氏不动杆菌为主;分离的革兰阳性球菌以肠球菌属居多,所分离出的病原菌对常用抗菌药物大多数呈现多药耐药趋势,革兰阴性杆菌中的铜绿假单胞菌对亚胺培南耐药率50.0%,对美罗培南耐药率为43.3%;鲍氏不动杆菌除对亚胺培南、美罗培南、头孢哌酮/舒巴坦和米诺环素耐药率≤25.0%外,对其余抗菌药物的耐药率均>75.0%。结论 ICU患者感染病原菌多药耐药情况严重,临床医师应参考ICU病原菌类型及耐药性,结合患者感染状况正确、合理用药。

OBJECTIVE To investigate the distribution of pathogens and the characteristics of antibiotic resistance in ICU.METHODS The bacteria isolated from ICU in 2009 were retrospectively analyzed.Antibiotic resistance was carried out by means of Kirby-Bauer（K-B）,the results were analyzed according to CLSI 2007 standards.RESULTS Of all the 200 isolated strains,Gram negative bacilli,Gram positive cocci and fungi1 accounted for 63.0%,24.5%and 2.5% respectively.Most of the isolated pathogens presented multi-drug resistance in tendency to common antimicrobial agents.The drug resistance rates of P.aeruginosa against imipenem and meropenem were 50.0% and 43.3%.The drug resistance rates of A.baumanii to imipenem,meropenem and cefoperazone-sulbactam were lower than 25.0%,but the drug resistance rates to other antimicrobial agents were higher than 75.0%.CONCLUSION The pathogens isolated from ICU exhibit serious multi-drug resistance.Clinical doctors should give the patients a correct and rational drug application by referring to the types of pathogens and the drug resistance,combining with the infection condition.