2007-2011年SICU医院感染病原菌耐药性分析

Drug resistance of pathogenic bacteria causing nosocomial infections in SICU from 2007 to 2011

目的了解医院外科重症病房(SICU)2007-2011年医院感染病原菌分布及耐药性特点,从而指导临床抗菌药物经验治疗。方法采用法国生物梅里埃公司生产的ATB Expression系统及ID 32GN试剂盒进行细菌鉴定,采用SPSS13.0软件进行统计分析,使用χ2检验方法对各种率进行统计分析,P<0.05为差异有统计学意义。结果 2007-2011年共收集SICU医院感染病原菌821株,其中革兰阳性菌221株占26.9%,革兰阴性菌600株占73.1%;占前5位的有鲍氏不动杆菌、铜绿假单胞菌、耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)、肠球菌属及大肠埃希菌,分别占33.9%、15.7%、12.9%、8.9%及7.3%;标本来源占前3位的是痰液、血液和引流液,分别占42.0%、22.0%和16.3%;鲍氏不动杆菌、铜绿假单胞菌对临床上使用的抗菌药物保持很高的耐药性,鲍氏不动杆菌对头孢哌酮/舒巴坦耐药率最低为4.2%～17.4%,铜绿假单胞菌对磺胺甲噁唑/甲氧苄啶耐药率最高,5年均>80.0%,对阿米卡星的耐药率最低为6.5%～26.3%,未发现耐万古霉素、替考拉宁和利奈唑胺的MRCNS和肠球菌属,大肠埃希菌对碳青霉烯类仍保持最低的耐药率。结论 SICU细菌来源仍然以非发酵菌、MRCNS、肠球菌属、大肠埃希菌为主,细菌的耐药性严重,需要继续密切监测SICU病原菌的耐药变化趋势并指导抗菌药物使用。

OBJECTIVE To investigate the distribution and drug resistance of pathogenic bacteria causing nosocomial infections in the surgical intensive care unit （SICU） from 2007 to 2011 so as to guide the clinical drug therapy. METHODS The identification of the bacteria was performed with the use of ATB Expression System of French company BioM6rieux and ID 32 GN kit, the SPSS 13.0 was used for statistical analysis, X2 test was carried out for the statistical analysis of the various rates, and P ~0.05 was considered to be statistical significance. RESULTS A total of 821 strains of pathogens causing nosocomial infections in the SICU from 2007 to 2011 were isolated, including 221 （26. 9%） strains of gram-positive bacteria and 600 （73. 1%） strains of gram-negative bacteria; the Acinetobacter baumannii , methicilion-resistant coagulase-negative Staphylococcus, Pseudomonas aeruginasa, Enteracoccus spp and Es＇cherichia coli ranked the top five species of pathogens, accounting [or 33.9%, 15.7%, 12.9%, 8.9% and 7.3% respectively. The sputum, blood, and drainage liquid were the top three specimen sources, accounting for 42. 0%, 22. 0%, and 16. 3% respectively. The A. baumannii and P. aeruginosa remained high resistance rate to the clinically used antibiotics; the drug resistance rate of A. baumannii to cefoperazone-sulbactam was the lowest, varying from 4. 2% to 17. 4%; the drug resistance rate of the P. aeruginosa to sulfamethoxazole-trimethoprim was the highest （more than 80. 0% within five years）, the drug resistance rate to amikacin was the lowest, varying from 6.5 % to 26.3%; no strains of MRCNS or Enterococcus spp were found resistant to vancomycin, teicoplanin, or linezolid~ the E. coli remained the lowest drug resistance rate to earbapenems. CONCLUSION The non-fermenting bacteria, MRCNS, Enterococcus spp and E. coli remain the predominant species of pathogens isolated from the SICU and are highly drug resistant, it is necessary to attach great importance to the monitoring of Change of drug resistance of the pathogens so as to guide the reasonable use of antibiotics.