重症监护病房医院感染菌分布与耐药性分析

Distribution and Drug Resistance of Nosocomial Infection Bacteria in Intensive Care Unit

了解哈尔滨医科大学附属第一医院重症监护病房(ICU)病原菌的分布特点及耐药性,为临床治疗提供理论依据。对2003年1月至2010年12月ICU患者送检的标本进行培养,用API鉴定系统或VITEK 2 Com-pact全自动细菌鉴定仪进行菌种鉴定及药敏分析,对检出菌株的构成、标本的分布及药敏结果进行分析。共分离出4 197株病原菌,其中革兰阴性杆菌52.1%、革兰阳性球菌22.3%、真菌25.6%;革兰阴性杆菌中非发酵菌占主要地位(37.5%),以鲍曼不动杆菌为主(13.1%);而肠杆菌科细菌则以肺炎克雷伯菌(9.5%)及大肠埃希菌(5.1%)为主;革兰阳性球菌以金黄色葡萄球菌(14.6%)为主,真菌以白假丝酵母菌(11.8%)为主;在检出所有病原菌的标本中,前3位依次为痰液(79.1%)、血液(8.4%)、无菌体液(8.1%);细菌耐药性结果表明,大肠埃希菌及肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)阳性率分别为66.4%、56.3%。几种主要病原菌对各类抗菌药物的耐药程度各不相同,但大部分菌株均呈现多重耐药的现象。产酶菌的耐药率普遍高于非产酶菌,哌拉西林/他唑巴坦对产酶菌及非产酶菌的抑菌效果都很明显;美罗培南、亚胺培南和头孢替坦对肠杆菌科细菌耐药率最低均在40%以下,可作为产酶菌的首选药;鲍曼不动杆菌耐药性严重耐药率均在50%以上。耐甲氧西林葡萄球菌(MRS)检出率为70.1%,其中耐甲氧西林金黄色葡萄球菌(MRSA)75.8%,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)38.7%。万古霉素、替考拉宁和利奈唑烷可作为革兰阳性球菌严重感染的首选药物。ICU患者以呼吸道感染为主,病原菌以鲍曼不动杆菌和金黄色葡萄球菌为主,且多为多重耐药菌。真菌感染率增加且真菌对药物的敏感性好。应动态监测ICU病原菌的流行和耐药情况,从而控制医院内感染,减少耐药菌株的产生。

In order to provide theoretical foundation for clinical treatment distribution feature and drug resistance of nosocomial bacteria in ICU in the first affiliated hospital of First Clinical College of Harbin Medical University were in- vestigated. All samples delivered for tests collected from the ICU since January 2003 to December 2010 was cultured. The species identification and drug sensitivity analyses were performed using API systems or VITEK 2 Compact full- automatic bacterial identification instrument, then the strain composition, sample distribution, and the result of drug sensitivity were analyzed. The results showed that of all 4 197 isolated strains, Gram-negative bacilli, Gram-positive cocci and fungi accounted for 52.1% , 22.3% , and 25.6% , respectively. Among the Gram-negative bacillus, non- fermenter bacteria occupied the main position （37.5%） ; Acinetobacter baumannii was the main one （ 13.1% ）. However, the main pathogenic bacteria from Enterobacteriaceae were KlebsieUa pneumoniae （9.5%）, E. coli（ 5.1% ）. Among the Gram-positive cocci, the main bacteria were Staphylococcus aureus （ 14.6% ）, and the main fungus was Candida albicans （ 11. 8% ）. Among all of the positive specimens, the three most common ones were sputum （79.1%）, blood （8.4%）, and body fluids （8： 1% ） respectively. The results of the drug resistance showed the ES- BLs positive rate producing E. coil and K. pneumoniae were 66.4% and 56.3% respectively. Majority of pathogen exhibited multiplex drug resistance against kinds of antibiotics at different levels. The drug resistance rates of ESBLs producers were commonly higher than that of non-producers. The inhibiting effect of piperacillin/tazobactam was obvi- ous to either ESBLs producers or non-producer, especially for ESBLs producers. The resistance rates of Enterobacteriaceae to meropenem, imipenem and CTT were less than 40% , therefore could be the first choice medicine for the ES- BLs producers ; the grave drug resistance rates of A. baumannii to each antimierobial agents were over 50.0%. MRS was detected at 70.1% , MRSA and MRCNS were 75.8% and 38.7% respectively. Gram-positive cocci were sensi- tive to vaneomyein, teicopanin, and linezolid. The main patients in ICU were respiratory tract infection, and the main pathogens were A. baumannii and S. aureus and mainly were multiplex resistance. The fungal infection rate was in- creasing; however, fungi have good drug sensitivity. Therefore, dynamic monitor to the prevalence and drug resistance of the pathogens in ICU should be performed thereby to control nosocomial infection and to reduce the drug resistant strains.