重症监护病房临床分离需氧菌分布与耐药性分析

Distribution and drug resistance of aerobic bacteria isolated from intensive care unit

目的了解本院重症监护病房临床分离需氧菌的分布及耐药情况,为临床合理使用抗菌药物提供依据。方法采用ATB仪进行细菌鉴定,K-B法进行药敏试验及耐药性分析,按CLSI2011年标准判定药敏结果,并用WHONET5.6软件进行数据分析。结果分离出的858株病原菌中,常见的主要为肺炎克雷伯氏菌(151株,17.6%)、金黄色葡萄球菌(113株,13.2%)、铜绿假单胞菌(111株,12.9%)、鲍曼不动杆菌(82株,9.5%)、嗜麦芽窄食单胞菌(69株,8.0%)、大肠埃希氏菌(62株,7.2%)。从耐药性分析来看,碳青霉烯类仍是敏感率最高的抗生素,但已出现亚胺培南和厄他培南耐药的菌株。葡萄球菌属尚未发现对万古霉素、利奈唑胺、奎奴普丁/达福普汀、替考拉宁耐药株,但对其他多种抗菌药物存在不同程度的耐药性。非发酵菌对多种抗菌药物存在不同程度的耐药性。结论加强ICU感染管理以及病原菌耐药情况的监测,合理使用抗菌药物,降低临床感染的发生率和病原菌耐药率。

Objective To learn the distribution and drug resistance of aerobic bacteria isolated from intensive care unit in Jiangmen Central Hospital and provide the clinical basis for rational use of antibiotics. Methods Strain indentification identified by ATB Expression system, drug sensitive test adopted K-B method and the results determined by CLSI 2011 standards, and used WHONET5.6 software for data analysis. Results 858 strains of aerobe were isolated, The Common aerobe are Klebsiella pneumoniae （151 strains,17.6%）, Staphylococcus aureus （113 strains, 13.2 %）, Pseudomonas aeruginosa （111 strains, 12.9 %）, Acinetobacter baumannii （82 strains, 9.5%）, Stenotrophomonas maltophilia （69 strains, 8.0%）, Escherichia coli （62 strains, 7.2%）. According to analysis of drug resistance, Carbapenem antibiotics on Enterobacteriaceae bacteria was still the highest rate of antibiotic-sensitive, but imipenem-resistant and（or） ertapenem-resistant strains had emerged. Drug-resistant to vancomycin, linezolid, quinupristin / dalfopristin, teicoplanin had not yet been found in Staphylococcus., and there were varying degrees of resistance to other antibiotics. Non-fermenting bacteria had different degrees of resistance to most antibiotics. Conclusion We should enhance the management of infection and the monitoring of bacterial resistance in ICU in order to reduce the infection rate in hospital and the resistance rate of bacteria.