重症监护室感染病原菌分布和耐药性分析

Distribution and resistance of pathogens isolated from ICU

目的分析重症监护室病原菌分布及抗菌药物的敏感性。方法采用API鉴定系统鉴定细菌及真菌；纸片扩散法测定细菌药物敏感性，Rosco纸片法测定真菌药物敏感性。结果临床分离的2014株菌中，革兰阴性菌1324株（65．7％），革兰阳性菌385株（19．1％），真菌305株（15．1％）。其中，检出率最高的病原菌是鲍曼不动杆菌（19．I％，385株）和克雷伯菌属（15．5％，311株），占阳性标本的34．6％；其次是铜绿假单胞菌（11．4％，229株）和大肠埃希菌（8．8％，177株）。大肠埃希菌和肺炎克雷伯菌中，产超广谱8内酰胺酶（ESBL）菌株阳性率分别为73．O％和65．0％。革兰阳性球菌以金黄色葡萄球菌为主（207株，10．3％）。大肠埃希菌和肺炎克雷伯菌对氨苄西林、头孢吡肟和头孢他啶的敏感率均低于40．0%，而对美洛培南、亚胺培南敏感性则可达90．O％以上；鲍曼不动杆菌对美洛培南、亚胺培南和氨苄西林／舒巴坦敏感性约为30．oH。革兰氏阳性球菌对万古霉素的敏感率为90．O％～100．0％。真菌以白色假丝酵母菌为主，对5-氟胞嘧啶、氟康唑、伊曲康唑、伏立康唑和两性霉素B的敏感率高于90．O％。结论ICU病房病原菌检出率高，且常为条件致病菌和多重耐药菌，耐抗菌药物种类广，耐药性强，应加强抗菌药物合理应用。

Objective To analyze the pathogen distribution and resistance pattern of the positive clinical specimens from ICU. Methods The bacteria and fungi were identified hy API system and the susceptibility of antimicrobial and antifungal agents was tested by KB and Rosco disk diffusion method. Results Of 2014 strains, 1324 strains （65.7%） of Gram-negative bacilli, 385 strains （19.2%） of Gram-positive cocci and 305 fungi （15.1%） were isolated and collected in the gerontology division. The highest detection rates of the pathogens were acinetobacter baumannii （19.1%,385 strains） and crayreseareh bacteria genera （15.5%, 311 strains） i which accounted for 34.6% positive specimens. The second detection rates of the pathogens were pseudomonas aeruginosa （11.4%, 229 strains） and escherichia coli （8. 8G, 177 strains）. Among the Enterobacteriaceae, ESBLs-producing E. coli accounted for 73% and 65% in K. pneumoniae. Among Gram positive cocci, staphylococcus aureus accounted for 207 strains（10.3%）. The sensitivity rates of E. coli and K. pneumoniae to ampicillin, cefepime and ceftaziclime were below 40%, while those of meropenem and imipenem were more than 90%. The sensitivity rates of baumanii to meropenem, imipenem and ampicillin/ sulhactam were higher than 30%. The sensitivity rates of Gram positive coccus to vancomycin was 90% to 100%. Most of isolated fungi were Candida albicans, and they were highly susceptible to 5-flurocy-tosine, fluconazol6, itraconazole, voriconazole and amphotericin B with the sensitivity rates more than 90%. Conclusion The detection rates of the pathogens in our ICU division are higher, which are resistant to many antimicrobial agents. Attention should be paid to using antimicrobial agents rationally.