重症监护病房临床分离致病菌及其耐药性的调查分析

Drug resistance of clinic isolates in intensive care unit

目的了解常德市第一人民医院重症监护病房(ICU)连续3年病原菌分布及耐药变迁。方法对我院ICU 2008～2010年所分离的病原菌分布及其耐药性进行回顾性分析。结果临床分离菌总数增加,其中G-菌由2008年的250株增加至2010年的316株,占65.2%。2008年分布排序前三位的G-菌,依次是铜绿假单胞菌(27.1%)、不动杆菌(22.3%)、金黄色葡萄球菌(11.6%);2010年前三位的G-菌是不动杆菌(38.8%)、金黄色葡萄球菌(16.1%)、铜绿假单胞菌(12.6%)。药敏结果显示,主要G-菌均呈多重耐药性。对常见G-菌耐药率较低的有亚胺培南、头孢哌酮/舒巴坦、阿米卡星和左氧氟沙星。三年中总耐药率最低的是亚胺培南。结论 ICU分离的G-菌有增多趋势。细菌耐药形势严峻。不动杆菌对亚胺培南和左氧氟沙星敏感性最高,铜绿假单胞菌对亚胺培南和阿米卡星敏感性最高,万古霉素、替考拉宁和多西环素对G+球菌敏感性较好。

Objective To investigate the changes of distribution and drug resistance among the clinic isolates from intensive care unit（ICU）.Methods All the pathogens isolated from ICU were retrospectively analyzed.Results The total number of clinical isolates increased in years,and the isolates of Gram-negative bacilli increased from 250 in 2008 up to 316 in 2010 and accounted for 65.2%.The three most common encountered Gram-negative bacilli in 2008 were Pseudomonas aeruginosa（27.1%）,Acinetobacter spp.（22.3%）and Staphylococcus aureus（11.6%）,respectively,while those in 2010 were Acinetobacter spp（38.8%）,Staphylococcus aureus（16.1%）and Pseudomonas aeruginosa（12.6%）,respectively.The antibiotics resistance text showed that the main Gram-negative bacilli strains were all in multi-drug resistance.The common Gram-negative bacilli strains showed relatively low resistance to imipenem,cefoperazone/sulbactam,amikacin and levofloxacin.The resistant rate of imipenem was the lowest.Conclusion The isolated rate of Gram-negative bacilli in ICU increases.The condition of the drug-resistance is very serious.Imipenem and levofloxaxin have the strongest antibacterial activity against Acinetobacter spp.Imipenem and amikacin have the strongest antibacterial activity against Pseudomonas aeruginosa.Vancomycin,teicoplanin and doxycycline remained highly active against Gram-positive cocci.