重症监护病房革兰阴性杆菌分布及其耐药性分析

The distribution and drug resistance analysis of gram-negative bacterium in intensive care unit

目的:了解我院重症监护病房(ICU)革兰阴性(G-)杆菌分布情况及其耐药特征,为临床合理应用抗菌药物提供依据。方法:对2007年7月-2009年12月期间ICU送检的痰液、血液、分泌物、尿液、导管尖及各种引流液等各类标本进行细菌培养、分离与鉴定并进行抗菌药物敏感试验,同时检测大肠埃希菌和肺炎克雷伯菌的超广谱β-内酰胺酶(ESBLs)。结果:共分离出313株革兰阴性杆菌,主要病原菌的检出率依次是铜绿假单胞菌23.0%,大肠埃希菌17.6%,鲍曼不动杆菌14.7%,肺炎克雷伯菌13.7%,阴沟肠杆菌9.6%,嗜麦芽窄食单胞菌为8.0%。70.9%分离菌株来自痰液标本。亚胺培南对除嗜麦芽窄食单胞菌外的其他革兰阴性杆菌具有很好的抗菌活性;嗜麦芽窄食单胞菌对头孢他啶,头孢哌酮-舒巴坦、左氧氟沙星、复方新诺明较敏感;大肠埃希菌和肺炎克雷伯菌产ESBLs菌株分别占58.2%和46.5%;产酶菌株对多数常用抗菌药物耐药率高于非产酶菌株,对亚胺培南无耐药;头孢哌酮-舒巴坦和哌拉西林-他唑巴坦对产ESBLs菌株抗菌活性明显强于其他头孢菌素。结论:ICU病房分离革兰阴性杆菌耐药严重,亚胺培南对除嗜麦芽窄食单胞菌外的其他革兰阴性杆菌具有较好的抗菌性。临床应根据药敏结果合理使用抗菌药物,以控制医院感染。

Objective：To investigate the distribution and drug resistance analysis of gram-negative bacterium in intensive care unit,so as to help physicians to choose reasonable antibiotics.Methods： All the samples from intensive care unit from 2007 to 2009,such as sputum,blood,secretion,urine,sharp of venous catheter and drainage solution,were cultured and tested.Then the drug susceptibility test and ESBLs test of E.coli and Klebsiella pneumoniae was carried out.Results： About 313 lines of gram-negative bacteriums were separated,the detection rate of Pseudomonas aeruginosa,E.coli,baumanii,Klebsiella pneumoniae,Enterobacter cloacae,stenotrophomonas maltophilia,were 23.0%,17.6%,14.7%,13.7%,9.6%,8.0%,respectively.About 70.9% lines of bacteriums are from sputum samples.Imipenem has direct effect on all gram-negative bacteriums except stenotrophomonas maltophilia.Stenotrophomonas maltophilia is sensitive to ceftazidime,cefperazone-sulbactam,levofloxacin,trimethoprim-sulfamethoxazole.ESBLs-positive E.coli and Klebsiella pneumoniae were about 58.2 % and 46.5 %.The resistance rate of ESBLs-positive bacteriums lines is higher than that of ESBLs-negative lines.All lines are sensitive to imipenem.Cefperazone-sulbactam and TZP are effective than that of other cephalosporins when they are applied to ESBLs-positive bacteriums.Conclusion： The infection of gram-negative bacteriums in intensive care unit is severe.Imipenem has direct effect on all gram-negative bacteriums except stenotrophomonas maltophilia.This results can help the physicians to choose reasonable drugs,so as to control the infection in hospital.