山东省ICU病原菌调查及耐药监测

Investigation of pathogens in ICU of Shandong Province and monitoring of drug resistance

目的监测山东省32所医院ICU感染病原菌分布,为抗菌药物的合理应用提供参考。方法根据各参与医院提供2009年9月-2011年6月ICU细菌培养和药敏结果,进行数据筛选及汇总分析。结果 2009年9月-2011年6月山东省32所医院ICU共分离出病原菌15 596株,主要来自于痰、血、尿,分别占72.6%、11.7%、6.1%;15 596株临床分离菌株中,革兰阴性杆菌占79.9%,革兰阳性球菌占12.2%,真菌占7.9%;非发酵菌在ICU感染病原菌中占据主导地位,病原菌耐药率均较高,铜绿假单胞菌仅对头孢哌酮/舒巴坦、阿米卡星、头孢吡肟耐药率较低,分别为22.3%、31.1%和37.7%,对其他药物的耐药率均>50.0%;鲍氏不动杆菌对抗菌药物的耐药率更高,除对米诺环素和头孢哌酮/舒巴坦的耐药率分别为28.1%和29.6%外,对其他药物的耐药率均>70.0%;在感染的革兰阳性球菌中,葡萄球菌属、肠球菌属等革兰阳性球菌对万古霉素、替考拉宁的耐药率较低,未发现对利奈唑胺耐药的菌株。结论 ICU患者以呼吸道感染为主,病原菌以革兰阴性杆菌为主,且多为多药耐药菌,革兰阴性杆菌感染中,非发酵菌占优势,多药耐药鲍氏不动杆菌需引起警惕。

OBJECTIVE To monitor the distribution of pathogens causing infections in ICU of 32 hospitals in Shandong province so as to provide reference for reasonable use of antibiotics. METHODS According to the results of bacterial culture and the drug susceptibility testing presented by the hospitals involved from Sep 2009 to Jun 2011, the statistics were screened and analyzed. RESULTS A total of 15 596 strains of pathogens were isolated from the ICU of 32 hospitals of Shandong province from Sep 2009 to Jun 2011, most of which were isolated from the sputum（72.6%） ,blood（11. 7%） ,and urine（6.1%）. In the 15 596 strains of the pathogenic bacteria, 79.9% were gram-negative bacilli, 12. 2% were gram-positive cocci, and 7. 9% were fungi. The dominant pathogenic .bacteria in ICU were non-fermenting bacteria, most of them showed high drug resistance. The drug resistance rates of Pseudomonas aeruginosa to cefoperazone/sulbactam, amikacin, and cefepime were relatively low, which were 22.3%,31. 1%, and 37. 7%, respectively, the drug resistance rates to other antibiotics were higher than 50.0%. The drug resistance rate of Acinetobacter bauraannii was even higher, except for the drug resistance rate of 28.1% to minocycline and 29.6 % to cefoperazone/sulbactam, the drug resistance rates to other antibiotics were higher than 70.0%. Among the gram-positive cocci causing infections,the drug resistance rates of Staphylococci and Enterococci to vancomycin and teicoplanin were relatively low, and no strains of linezolid-resistant strains were detected. CONCLUSION The gram-negative bacilli are the main pathogens causing the respiratory tract infections in the ICU patients, which are multidrug-resistant , the non-fermenting bacteria are dominant in the strains, it is necessary to pay attention to the multidrug-resistant A. baumannii.