重症监护病房院内感染病原菌分布、耐药性分析

Distribution and drug resistance profiles of pathogenic bacteria isolated from patients with nosocomial infection in intensive care unit

目的 了解综合性ICU 医院感染病原菌分布和细菌对药物敏感性，为临床合理选用抗菌药物提供科学指导。方法采用回顾性和前瞻性调查相结合的方法，搜集我院2009年1月-2011年12月综合ICU病房229例医院感染病人资料，并对其分离出的337株病原菌进行统计分析。结果 综合ICU病人获得性感染病原菌总体仍以革兰阴性杆菌（68.25%）为主。2009-2011年多重耐药鲍曼不动杆菌分离率分别为：39.13%、18.18%、15%，分离率明显下降（P〈0.05）。多重耐药铜绿假单胞菌、产ESBLs大肠埃希菌和肺炎克雷伯菌、耐甲氧西林金黄色葡萄球菌、凝固酶阴性葡萄球菌耐甲氧西林菌株3年间分离率变化没有统计学意义（P〉0.05）。综合ICU病人检出的革兰氏阴性杆菌对各种抗菌药物的敏感率总体有上升趋势。革兰氏阴性杆菌对碳青霉稀类抗菌素、替加环素、阿米卡星及哌拉西林/他唑巴坦的敏感性保持最高。革兰氏阳性球菌总体对万古霉素、喹努普汀/达福普汀、利奈唑胺、替加环素保持较好的敏感性，敏感率达100%。结论临床医务人员应严格掌握抗生素使用原则，合理用药，并通过有效的监测及预防措施降低细菌的耐药率以及医院感染发生率。

Objective o investigate the distribution and drug sensitivity of pathogenic bacteria isolated from patients with nosocomial infection in intensive care unit.Methods The clinical data were collected from 229 hospitalized patients with nosocomial infection in intensive care unit from 2009 to 2011.Results Gram-negative bacteria were the main pathogens（68.25%） in the intensive care unit.From 2009 to 2011,the annual isolation rate of multidrug-resistant baumanii showed a significant reduction with time（39.13%,18.18%,and 15%,respectively,P0.05）,while the prevalence of multidrug-resistant Pseudomonas aeruginosa,ESBLs-producing Escherichia coli and Klebsiella pneumoniae,methicillin-resistant Staphylococcus aureus,coagulase-negative staphylococci methicillin-resistant strains showed no significant changes in the 3 years（P0.05）.The overall sensitivity of gram-negative bacilli to the antimicrobial agents tended to increase with time.The Gram-negative bacilli remained highly sensitive to carbapenems,tigecycline,amikacin and piperacillin/tazobactam;the Gram-positive bacilli were highly sensitive to vancomycin,quinoline Nupu Ting/dalfopristin,linezolid,and tigecycline with sensitivity rates all reaching 100%.Conclusion Adherence to the principles of antibiotic use and effective monitoring and preventive measures are encouraged to reduce antibiotic resistance rates of the bacteria and the incidences of hospital infection.