重症监护室患者血流感染菌谱构成及耐药性分析

The distribution and resistance characteristics of pathogens from bloodstream infection in ICU

目的了解综合性医院重症监护室患者血流感染病原菌分布及其耐药性。方法回顾性调查2011年6月至2012年6月南昌大学第二附属医院ICU患者血培养情况,对分离菌株及其药敏结果进行统计分析,所有数据采用WHONET 5.5软件分析。结果 1764例患者血培养共分离获得482株病原菌,总阳性率为27.32%。其中革兰阳性球菌占39.83%(192/482),革兰阴性杆菌占51.04%(246/482),真菌占8.09%(39/482)。最常见的感染菌分别为凝固酶阴性葡萄球菌、洋葱伯克霍尔德菌、大肠埃希菌、鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌及金黄色葡萄球菌。金黄色葡萄球菌和表皮葡萄球菌的耐甲氧西林发生率分别为88.24%及90.48%,对青霉素的耐药率均为100%,未检测到耐万古霉素的葡萄球菌。金黄色葡萄球菌与表皮葡萄球菌比较,耐药率有统计学意义的只有复方新诺明,耐药率分别为5.88%和63.49%,金黄色葡萄球菌对复方新诺明(5.88%)和夫西地酸(11.76%)耐药率较低;大肠埃希菌与肺炎克雷伯菌耐药率最低的是亚胺培南,分别为13.04%及11.11%;铜绿假单胞菌对亚胺培南的耐药率为20.00%,而鲍曼不动杆菌对亚胺培南的耐药率高达92.68%。结论凝固酶阴性葡萄球菌、洋葱伯克霍尔德菌、鲍曼不动杆菌等是重症监护室患者血流感染的常见病原菌,其耐药及多重耐药性均较严重。

Objective To understand the distribution and drug resistance characteristics of bloodstream infection pathogens from ICU patients in a general hospital.Methods Blood cultures of ICU patients from 2011 June to 2012 June were collected and the isolates and antimicrobial susceptibility results were statistically analyzed by WHONET 5.5.Results Four hundred and eighty-two strains of pathogens were isolated from 1 764 cases of blood cultures(27.32%),in which Gram-positive cocci accounted for 39.83%(192/482),Gram-negative bacilli 51.04%(246/482),and fungi 8.09%(39/482).The most common pathogenic bacteria were coagulase-negative Staphylococci,Burkholeria cepacia,Escherichia coli,Bauman acinetobacter,Klebsiella pneumoniae,Pseudomonas aeruginosa,and Staphylococcus aureus.The methicillin resistance rates of Staphylococcus epidermidis and S.aureus were 88.24% and 90.48% respectively,and the resistance rates to penicillin were 100%.No vancomycin-resistant Staphylococcus was detected.Comparinged S.aureus with S.Epidermidis,significant difference was only seen in their resistance to cotrimoxazole,which were 5.88% and 63.49% respectively.The resistance rates of S.aureus to cotrimoxazole(5.88%) and fusidic acid(11.76%) were low.The resistance rates of E.coli and K.Pneumoniae to imipenem were the lowest,which were 13.04% and 11.11% respectively.The resistance rate of P.aeruginosa to imipenem was 20%,while that of Bauman acinetobacter was up to 92.68%.Conclusion Coagulase-negative staphylococci,Burkholeria cepacia and Bauman acinetobacter are common pathogens in ICU patients with bloodstream infection,all of which are severelyboth resistant and multi-drug resistantce.