重症监护病房医院感染病原菌特点及耐药性分析

Characteristics and drug resistance of nosocomial infectious pathogens in intensive care unit.

目的了解重症监护病房(ICU)医院感染病原菌及其药敏特征,为临床抗感染治疗提供依据。方法对我院2008年1月至2009年6月在ICU发生的感染送检标本所分离的细菌及药敏特征进行回顾性分析。结果 ICU的医院感染病原菌以革兰阴性菌为主,占76.5%,其中大肠埃希菌42株,占第一位(30.00%);革兰阳性菌20株,占10.93%,以金黄色葡萄球菌为主;真菌23株,占12.57%,以白色假丝酵母菌为主;大肠埃希菌和克雷伯菌属产超广谱β内酰胺酶(ESBLs)株分别为29株和13株,各占20.71%和9.29%。未发现产ESBLs株对亚胺培南的耐药株。耐甲氧西林金黄色葡萄球(MRSA)6株,占54.54%;凝固酶阴性葡萄球菌8株,耐甲氧西林凝固酶阴性葡萄球菌(MRSCON)6株,耐药率75.0%。未检出耐万古霉素菌株(VRE)。结论 ICU感染以革兰阴性杆菌为主,但革兰阳性球菌仍是重要的致病菌。碳青霉烯类抗生素仍是目前耐药性最低的一类抗生素。尽早行细菌培养,根据药敏结果及时选用敏感抗生素是减少耐药性的有效方法 。

Objective To investigate the nosocomial infectious pathogens of intensive care unit（ICU） and their drug resistance characteristics,and to provide evidences for chinical anti-infection treatment.Methods A retrospective analysis was carried out to clarify the pathogens and their drug resistance characteristics of infectious specimens collected from ICU from January 2008 to June 2009.Results Gram-negative bacteria were the major nosocomial infectious pathogens（140/183,76.5%）;of the Gram-negative bacteria,Escherichia coli was most commonly found（42/140,30%）.Gram-positive bacteria isolates amounted 20（20/183,10.93%）,and Staphylococcus aureus was predominant.Fungi isolates amounted 23（23/183,12.57%）,and Candida albicans was predominant.Extended-spectrum beta-lactamases（ESBLs）-producing E.coli and Klebsiella isolates amounted 29（20.71%） and 13（9.29%） respectively.No ESBLs-producing isolates were found resistant to imipenem.There were 6 isolates（54.54%） of meticillin-resistant S.aureus（MRSA）,8 isolates of coagulase negative staphylococcus,and 6 isolates of methicillin-resistant coagulase-negative Staphylococcus（MRCoNS） with methicillin resistence rate of 75%,and no vancomycin-resistant Enterococcus（VRE） isolate was found.Conclusion Gram-negative bacteria are the major nosocomial infectious pathogens and Gram-positive bacteria are important nosocomial pathogens.Carbapenem antibiotics are still the most senstive antibiotics.Immediate bacterial culture and anti-infection treatment according to drug sensitivity tests are effective to lower drug tolerance.