重症医学科患者医院获得性感染的病原菌分布及耐药性分析

Distribution and drug resistanc of pathogenic bacteria from infections causing hospital-acquired patients in ICU

目的探讨某院重症医学科(ICU)住院患者医院获得性感染的病原菌分布及耐药性情况,为临床合理使用抗菌药物提供理论依据。方法对该院2010年1月—2012年12月收住ICU患者各类临床标本分离的菌株的鉴定和药敏实验进行回顾性分析。结果共检出129株病原菌。检出前5位的细菌分别是鲍氏不动杆菌(26.36%)、大肠埃希氏菌(13.95%)、铜绿假单胞菌(10.08%)、嗜麦芽窄食假单胞菌(9.30%)和金黄色葡萄球菌(6.20%)。在真菌感染方面,培养出白色假丝酵母菌和光滑假丝酵母菌各3株,未发现曲霉等菌株。在耐药性方面,鲍曼不动杆菌、大肠埃希氏菌、铜绿假单胞菌和嗜麦芽窄食假单胞菌对亚胺培南的耐药率分别为35.29%、5.56%、23.08%、100%。葡萄球菌未发现有对万古霉素和利奈唑胺耐药的菌株,MRSA及MRCNS的检出率分别为50.00%和52.94%。结论 ICU住院患者医院获得性感染以革兰阴性杆菌为主,具有高耐药性,故在临床工作中必须把重点放在合理地使用抗生素和预防感染上。

Objective To explore the pathogenic bacteria distribution and drug resistance characteristics of hospital - acquired infection patients in a hospital intensive care unit （ ICU）, and to provide theoretical bases for clinical rational use of antibiotics. Methods Retro-spective analysis was performed on strains isolated of various clinical specimens from hospitalized patients in the hospital ICU between January 2010 and December 2012. The pathogens were identified and their drug susceptibility was detected. Results Among the 129 strains isolated from patients, top five bacteria were Acinetobacter banmannii （ 26.36% ）, Escherichia coli. （ 13.95% ）, Pseudomonas aeruginosa （ 10.08 % ）, Stenotrophomonas maltophilia （ 9.30 % ） and Staphylococcus aureus （ 6.20 % ）. Fungal infections, Candida albicans and Candida glabrata were three for each strain, Aspergillus and other strains were not found. The resistance rates of Acinetobacter bau- mannii,Escherichia coli, Pseudomonas aeruginosa, Stenotrophomonas maltophilia to imipenem were 35.29%, 5.56%, 23.08% and 100%. No Staphylococcus strain was resistant to vaneomycin and linezolid. The detection rates of MRSA and MRCNS were 50.00% and 52.94%, respectively. Conclusion Hospital-acquired infections in ICU are mainly caused by gram-negative bacillus, and have high re-sistance. In the clinical work ,we must focus on the rational use of antibiotics and infection control.