重症监护病房患者感染病原菌分布及耐药性分析

Distribution and drug-resistance of pathogensis of patients in intensive care unit

目的了解重症监护病房（ICU）感染患者病原菌分布和耐药情况,为临床细菌感染性疾病经验性治疗及合理使用抗生素提供依据。方法对天津医科大学总医院急诊ICU送检标本进行培养、分离、鉴定和药敏试验并对其结果进行统计学分析。结果 2009年1-12月送检标本中共分离出病原菌302株,革兰阴性菌163株（54.0%）,其中不动杆菌（35株）、肺炎克雷伯菌（31株）、铜绿假单胞菌（28株）、大肠埃希菌（26株）、阴沟肠杆菌（14株）;163株革兰阴性菌中共检出超广谱β内酰胺酶（ESBLs）19株,检出率11.7%,其中产ESBLs的肺炎克雷伯菌6株,产ESBLs的大肠埃希菌13株,其余菌种中均未检出产ESBLs。革兰阳性菌49株,主要革兰阳性菌为葡萄球菌19株;肠球菌23株,其中耐甲氧西林金黄色葡萄球菌占葡萄球菌的52.6%,耐高浓度氨基糖苷类肠球菌占肠球菌的73.9%。真菌90株,以白色假丝酵母菌为主,占真菌分离数的78.9%。所检测病原菌对抗生素均有不同程度的耐药,其中革兰阴性菌对临床常用抗生素总体耐药率最低的是美罗培南、亚胺培南,分别为4.7%和2.2%,而氨苄西林的耐药率最高,为86.6%（116/134）。结论了解急诊ICU患者常见致病菌菌群分布及耐药性特点,有助于临床根据不同情况合理、安全选用抗生素,对控制医院感染至关重要。

Objective To investigate the distribution and antimicrobial resistance of pathogens isolated from the Emergency Intensive Care Unit,so as to provide theoretical bases of rational usage of antibiotics and experienced therapy for the clinic.Methods Identification and susceptibility of pathogens were performed by SPSS 17 software for analysis of the bacterial sensitive data.Results A total of 302 organisms were collected in the survey period,including 163 gram-negative strains（54.0%）,Acinetobacter spp 35 strains,Klebsiella spp 31 strains,Pseudomonas aeruginosa 28 strains,Escherichia coli 26 strains,Enterobacter cloacae 14 strains.A total of 19 strains of ESBLs were detected from 163 gram-negative strains,the isolating rate was 11.7%,including Klebsiella spp 6 strains and Escherichia coil 13 strains.There were 49 gram-positive strains and 90 fungal strains.Conclusion Investigating the distribution and drug-resistance of pathogensis of patients in ICU is helpful for reasonable and safe application of antibacterials according to different clinical situation,and it is very important for controlling the hospital infection.