重症监护病房感染病原菌分布和耐药分析

Analysis of distribution and drug reisitance of pathogens in ICU

目的分析重症监护病房(ICU)感染患者的病原菌分布及耐药性。方法收集ICU2010年1-12月各类感染标本,分离出病原菌528株,以法国生物梅里埃公司vitekII全自动细菌鉴定仪鉴定菌种,采用K-B法进行药物敏感实验,使用WHONET 5.6软件进行耐药分析。结果 528株病原菌中,革兰阴性菌80.3%,革兰阳性菌12.7%,真菌7.0%;铜绿假单胞菌位居第一(26.1%),其次是鲍曼不动杆菌24.2%,大肠埃希菌5.5%,肺炎克雷伯菌5.3%,金黄色葡萄球菌4.7%。铜绿假单孢菌和鲍曼不动杆菌的耐药率分别高于70.0%和78.0%(除头孢哌酮/舒巴坦和米诺环素),肠杆菌科细菌对头孢类的耐药率高于55.0%,对碳青霉烯类的亚胺培南和美洛培南耐药率分别为11.2%和10.1%。结论 ICU感染病原菌以革兰阴性菌为主,对多种抗菌药物耐药率高,应重视合理应用抗菌药,有效控制院内感染。

Objective To analyze the bacterial distribution and resistance of pathogens isolated from infection patients in intensive care unit（ICU）. Methods A total of 528 strains was isolated from all kinds of clinical specimens of patients in ICU from January to December of 2010.Pathogens were indentifid by France bioMerieux vitekII automatic bacterial identification system.K-B tests were conducted to detect drug sensitivity. WHONET 5.6 was applied to analyze the bacterial distribution and drug resistance. Results Gram-negative strains accounted for 80.3% in 528 isolated strains of pathogenic bacteria.Gram-positive strains accounted for 12.7% and fungi accounted for 7%. The top 1 bacteria was Paeudomonas aeruginosa（26.1%）,which was followed by Acinetobacter baumannii（24.2%）,Escherichia coli（5.5%）,and Klebsiella pneumoniae（5.3%）.The resistance rates of Paeudomonas aeruginosa and Acinetobacter baumannii to all the antimicrobial agents were greater than 70.0% and 78.0%（except for cefoperazone/sulbactam and minocyline）.The resistance rate of Enterbacteriaceae to cephalosporins was greater than 55.0%.The resistance rates of Enterbacteriaceae to imipenem and meropenem were 11.2% and 10.1%,respectively. Conclusion The main pathogens in ICU were Gram-negative strains,which were highly resistant to many kinds of antimicrobial agents.