ICU消毒前后病原菌构成及耐药性变迁分析

Composition of pathogenic bacteria after thorough disinfection in ICU and variance of drug resistance

目的观察ICU进行彻底消毒前后病原菌构成与耐药性的变化,为医院感染防治提供理论依据。方法对ICU进行彻底消毒并空闲至少3个月后,只收新患者,并严格按照医院感染防治方法进行管理,标本按常规方法留取、送检;采用法国生物梅里埃公司VITEK-2 Compact自动微生物鉴定仪及配套药敏卡进行菌株鉴定与药敏测定。结果消毒后病原菌检出数量减少47.9%,其分布与耐药分布有很大变化,临床分离的病原菌仍以革兰阴性杆菌为主;检出量减少的病原菌主要有:肺炎克雷伯菌由33株减少至18株;铜绿假单胞菌由32株减少至21株;表皮葡萄球菌由16株减少至4株;真菌由77株减少至14株;消毒后检出量增多的病原菌主要有:洋葱伯克霍尔德菌由11株增至19株;屎肠球菌由6株增至13株;ESBLs阳性肺炎克雷伯菌和大肠埃希菌比例明显上升,分别由36.4%和57.7%上升至50.0%和81.3%。结论全面、彻底消毒是减少医院感染的有效措施,但抗菌药物的选择仍面临巨大挑战。

OBJECTIVE To analyze the pathogen distribution and the drug resistance in ICU,so as to provide the evidence for treatment.METHODS The ICU ward was thoroughly disinfected and idled for at least 3 months before accepting the first patients.And in strict accordance with the management of nosocomial infection control methods,the pathogens from specimens were cultivated,isolated,as well as identified and classified with VITEK2-compact automatic system.RESULTS The number of pathogen was reduced by 47.9%.Gram-negative bacilli were the most common bacteria.There were significant changes in pathogens distribution and drug distribution.The number of Klebsiella pneumonias,Pseudomonas aeruginosa,Staphylococcus epidermidis and fungi was reduced from 33 to 18,32 to 21,16 to 4 and 77 to 14,respectively.The strains which were increased after disinfection were Pseudomonas cepacia（from 11 to 19）,feces Enterococcus（form 6 to 13）.The proportion of ESBLs in K.pneumoniae and E.coli increased from 36.4% and 57.7% to 50.0% and 81.3%,respectively.CONCLUSION A comprehensive and thorough disinfection is an effective measure to reduce nosocomial infections,however,the choice of antibiotics is still facing great challenges.