镜湖医院ICU感染患者病原菌分布及耐药性分析

Distribution of pathogens and antimicrobial resistance in ICU of KWH

目的通过了解ICU感染患者病原菌分布和耐药特点,为临床医师提供经验性及更替使用敏感抗菌药物提供合理依据。方法对2007年1月-2009年12月ICU送检标本所分离的病原菌及其耐药特点进行回顾性分析。结果共分离病原菌359株,其中革兰阴性杆菌192株,占53.5%,革兰阳性球菌97株,占27.0%,真菌70株,占19.5%;革兰阴杆菌主要为铜绿假单胞菌、鲍氏不动杆菌、肺炎克雷伯菌、大肠埃希菌及嗜麦芽寡养单胞菌,分别占16.4%、11.7%、8.6%、6.1%、5.3%;肺炎克雷伯菌和大肠埃希菌产超广谱β-内酰胺酶(ESBLs)的检出率分别为32.3%和40.9%;多数革兰阴性杆菌对亚胺培南、美罗培南、阿米卡星和哌拉西林/他唑巴坦高度敏感;革兰阳性球菌以金黄色葡萄球菌、凝固酶阴性葡萄球菌为主,分别占10.8%、13.4%;其中耐甲氧西林金黄色葡萄球菌(MRSA)和凝固酶阴性葡萄球菌(MRCNS)检出率分别为60.0%及72.9%;革兰阳性球菌对万古霉素和利奈唑胺均高度敏感。结论重症监护病房患者感染病原菌以革兰阴性杆菌为主,大部分病原菌呈现高度耐药和多药耐药的特点;定期对ICU进行细菌流行病学调查和耐药分析十分重要。

OBJECTIVE To investigate the distribution of the pathogens and the bacterial resistance from ICU of Kiang Wu Hospital,in order to guide the empirical antimicrobial therapy for ICU doctor. METHODS Retrospective analysis was made on the bacteria distribution and antimicrobial resistance situation in our ICU department during the year of Jan 2007 to Dec 2009. RESULTS The isolation rate of G-bacilli were 192 strains（53.5%）,G＋ bacilli were 97 strains（27.0%）,most of the G-bacilli were Pseudomonas aeruginosa strains（16.4%）,Acinetobacter baumannii（11.7%）,Klebsiella pneumoniae（8.6%）,E.coli（6.1%） and S.maltophilia（5.3%）.The detection rates of ESBL-producing bacteria of K.pneumoniae and E.coli were 32.3% and 40.9%,respectively.Most of the G-bacilli were sensitive to imipemen,meropenem,amikacin and piperacillin/tazobactam.In G＋ cocci,Staphylococcus aureus was and CNS were the most prominent,accounting for 10.8% and 13.4%,respectively,among which the isolation rates of MRSA and MRCNS were 60.0% and 72.9%,respectively;all of G＋ cocci were highly sensitive to vancomycin and linezolid. CONCLUSIONS Most of the patients in ICU are infected with G-bacilli,and they are the multidrug-resistance strains,therefore drug resistance monitoring and distribution investigation of of the bacteria in ICU are important to control infection effectively.