ICU医院感染病原菌分布及耐药性分析

Distribution and drug resistance of pathogenic bacteria causing nosocomial infections in ICU

目的了解重症监护病房(ICU)医院感染病原菌分布及其耐药性,为临床合理用药提供可靠的理论依据。方法回顾性分析2011年医院ICU住院患者送检标本中分离的病原菌对临床常用抗菌药物的耐药性。结果共分离出病原菌454株,其中革兰阴性杆菌280株占61.7%,真菌112株占24.7%,革兰阳性球菌62株占13.6%;前4位革兰阴性菌分别为鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌和大肠埃希菌;主要标本来源为痰液91.0%,其次为尿液21.6%、血液7.1%,其中痰液标本中病原菌285株,占62.8%,其他病原菌169株占37.2%;分离的革兰阴性菌大多有多药耐药性,其中以鲍氏不动杆菌更为显著。结论 ICU感染的病原菌主要存在于下呼吸道,病原菌以革兰阴性杆菌为主,且耐药较严重,对疑有感染的患者应及时留取标本进行细菌鉴定,并依药敏结果调整用药,有效控制医院感染。

OBJECTIVE To study the distribution and drug resistance of pathogenic bacteria causing nosocomial infections in the intensive care unit （ICU） so as to provide theoretical basis for rational clinical treatment with antibiotics. METHODS The drug resistance status of the pathogens isolated from samples which were collected from patients in the ICU of the hospital in 2011 were retrospectively analyzed. RESULTS A total of 454 strains of pathogenic bacteria were isolated, including 280 （61.7 % ） strains of gram-negative bacilli, 112 （24.7 % ） strains of fungi, and 62 （13.6 %） strains of gram-positive cocci. The Acinetobacter baurnannii, Pseudornonas aeruginosa, Klebsiella pneumoniae and Escherichia coli ranked the top 4 places among the isolated pathogens; the pathogens were mainly isolated from the sputum specimens （91. 0%）, followed by urine （21. 6%） and blood （7. 1%）. Totally 285 （62.8%） strains of pathogens causing nosocomial infections were isolated from the sputum samples and 169 （37.2%） strains of pathogens causing other infections were isolated. Most of the isolated gram-negative bacteria had multiple drug resistance, especially the Aeinetobacter baumannii , with the multiple drug resistance more significant. CONCLUSION The pathogenic bacteria causing infections in ICU mainly distribute in the lower respiratory tract, the gram-negative bacilli are the predominant pathogens and are highly drug resistant. It is necessary for the patients suspect with infections to preserve the samples for bacterial identification in a timely manner and to adjust the use of antibiotics on the basis of drug susceptibility testing result so as to effectively control the nosocomial infections.