2009-2011年肝胆外科ICU病原菌分布及多药耐药趋势分析

Clinical distribution and drug resistance trends of pathogens in ICU of hepatobiliary surgery 2009-2011

目的研究医院肝胆外科ICU感染病原菌分布及多药耐药菌的变迁,以指导临床合理应用抗菌药物。方法对2009年9月-2011年9月肝胆外科ICU感染患者送检2257份标本分离的病原菌进行鉴定及多药耐药菌分析。结果共检出病原菌1576株,其中革兰阴性菌745株占47.27%,革兰阳性菌430株占27.29%,真菌401株占25.44%;标本主要来源于痰液、腹腔引流液、血液及胆汁;鲍氏不动杆菌、屎肠球菌、凝固酶阴性葡萄球菌的多药耐药菌检出率高居前3位,其中鲍氏不动杆菌及凝固酶阴性葡萄球菌的多药耐药率由67.44%、50.00%升至70.59%、61.7%,屎肠球菌多药耐药率则由58.82%降至46.00%;大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌产ESBLs检出率2009年9月-2010年9月分别为70.0%、48.08%及12.12%、2010年9月-2011年9月分别为45.61%、9.38%及0。结论肝胆外科ICU患者感染的主要病原菌以革兰阴性菌为主,但革兰阳性菌及真菌感染率有上升趋势;加强病原菌及其耐药性的检测、指导合理应用抗菌药物,对降低细菌耐药率至关重要。

OBJECTIVE To investigate the category, clinical distributions and drug resistance trends of the pathogens isolated from the patients in ICU of hepatobiliary surgery. METHODS The distribution and drug resistance of pathogenic bacteria isolated and identified from 2257 clinical specimens of hepatobiliary surgery ICU from Sep 2009 to Sep 2011 were analyzed. RESULTS A total of 1576 strains were isolated. Gram-negative bacteria accounted for 47. 27% （745 strains）, gram-positive bacteria for 27. 29% （430 strains）, fungi accounted for 25.44%（401 strains）. The specimens were mainly obtained from the sputum, abdominal drainage, blood, and bile; the top three pathogens were A. baurnannii, E. faeciurn and coagulase-negative Staphylococci, the multi- drug-resistant rates of A. baumannii and coagulase-negative Staphylococci increased respectively from 67. 44%, 50.00% to 70. 59% and 61. 7%, while the multidrug-resistant rate of E. faecium decreased from 58.82% to 46.00% ; the detection rates of ESBLs-producing E. coli, Klebsiella pneurnoniae and Pseudomonas aeruginosa were 70.0%, 48.08% and 12.12% during the period of Sep 2009--Sep 2010 and were 45.61%, 9.38% and 0 during the period of Sep 2010-Sep 2011. CONCLUSION The predominant pathogens isolated from hepatobiliary surgery ICU are gram-negative bacteria, but gram-positive bacteria and fungi are in increasing trend; it is crucial to intensify the detection of the pathogens and the drug resistance and guide the reasonable use of antibiotics to reduce the bacterial resistance.