ICU来源细菌耐药性监测

ICU source bacterial drug resistance monitoring

目的：了解我院重症监护病房（ICU）病原菌的分布特点及耐药性，为临床抗感染治疗提供理论依据。方法：采用纸片法、MIC法进行抗菌药物敏感性试验，使用WHONET5.6软件对我院2009年1月1日至2013年4月15日ICU来源的患者首次分离菌株进行分析。结果：共检出374株病原菌，其中革兰阴性杆菌67.4%，革兰氏阳性杆菌32.6%，前3位分别为鲍曼不动杆菌104株（27.8%）、铜绿假单胞菌48株（12.8%）、金黄色葡萄球菌40株（10.7%）；耐甲氧西林西林金黄色葡萄球菌和凝固酶阴性葡萄球菌的检出率分别为72.5%和52.7%，未发现耐万古霉素和耐利奈唑胺葡萄球菌；未见对万古霉素耐药的粪肠球菌和屎肠球菌；产ESBLs大肠埃希菌和肺炎克雷伯菌的比率分别为61.5％和72.2％；鲍曼不动杆菌对碳青霉烯类抗菌药物的耐药率达57.6％，检出泛耐药鲍曼不动杆菌30株。结论：ICU分离菌株对常用抗菌药物的耐药率较高，应采取积极措施加以控制。

Objective：To investigate the bacterial distribution and drug resistance among clinical isolates from ICU in our hospital. Methods：Disk diffusion test and MIC test were used to detect the antimicrobial sensitivity of clinical isolates from ICU in our hospital from Jan 1, 2009 to Apr 15, 2013, and the data were analyzed by WHONET 5.6 according to CLSI 2012 criteria.Results：A total of 374 clinical isolates were isolated during the survey period from ICU, of which gram negative rods and gram positive cocci accounted for 67.4%and 32.6%respectively, Acinetobacter baumannii （104 strains, 27.8%）, Pseudomonas aeruginosa （48 strains, 12.8%） and Staphylococus aureus （40 strains, 10.7%） were the three most common isolated species. The methicil in-resistant Staphylococcus aureus and coagulase-negative Staphylococci were 72.5%and 52.7%respectively. No strains of vancomycin-resistant or linezolid-resistant Staphylococci were detected. The rates of ESBLs-producing Escherichia coli and Klebsiel a pneumonia were 61.5%and 72.2%respectively. The carbapenem-resistant rate of Acinetobacter baumannii was over 57.6%, a total of 30 strains of pan-resistant Acinetobacter baumannii were detected out.Conclusions：Bacterial resistance in ICU is serious, effective measures should be taken to control it.