重症监护室病原菌分布及耐药性分析

Distribution and antimicrobial resistance of pathogens isolated from Intensive Care Unit

目的分析医院重症监护病房(ICU)病原菌分布及耐药性。方法对某三甲医院重症监护病房患者2008年1月至2010年12月病原菌分布和耐药性进行回顾性分析。结果 190例患者中,发生医院感染的47例,发生率24.7%;感染部位以呼吸道为主。细菌构成以革兰阴性杆菌为主(64.7%)。分离菌以铜绿假单胞菌、金黄色葡萄球菌和鲍曼不动杆菌最多见。鲍曼不动杆菌对亚胺培南、头孢吡肟、氨曲南、环丙沙星、左氧氟沙星及复方新诺明抗生素的耐药率达到60%以上。九成以上的铜绿假单胞菌对环丙沙星、左氧氟沙星、阿米卡星和妥布霉素体外敏感。肺炎克雷伯菌中体外敏感性大于80%的包括左氧氟沙星、妥布霉素、头孢吡肟、亚胺培南。金黄色葡萄球菌对氨苄西林、四环素、环丙沙星和左氧氟沙星的耐药率高于50%,而对万古霉素、奎奴普丁/达福普丁、呋喃妥因和利奈唑胺全部敏感。真菌对5种抗真菌药物的耐药率均小于10%。结论 ICU应定期进行病原菌的分布和耐药性监测,为临床合理用药提供依据。

Objective To analyze the distribution and drug-resistance of pathogens isolated from Intensive Care Unit （ICU）. Methods The retrospective analysis was conducted on distribution and drug-resistance profile of pathogens isolated in the ICU of a tertiary hospital from January 2008 to December 2010. Results Forty-seven cases were confirmed as nosocomial infection a- mong 190 patients, accounting for 24.7% of all infection. And most of strains were isolated from respiratory tract. Gram-negative bacillus account for about 64.7% of infection in ICU, and serve as the major pathogens. The top 3 bacteria isolated from ICU are Pseudomonas aeruginosa, Staphylococcus aureus and A cinetobacter baumannii. Over 60% of A. bcatmannii strains were resistant to carbapenems. Over 90% of P. aeruginosa strains were sensitive to ciprofloxacin, levofloxacin, amikacin and tobramycin. Thirty- seven percent of K. pneumoniae were ESBLs positive, and over 80% of K. pneumoni~ were sensitive to levofloxacin, tobramycin, cet^pime, imipenem. Over 50% of S. aurens strains were resistant to ampicillin, tetracycline, ciprofloxacin and levofloxacin, and all strains were sensitive to vancomycin, quinupristin/dalfopristin, nitrofurantoin and linezolid. The resistance rates of fungi to five kinds of antifungal were less than 10%. Conclusion Continuous monitor of distribution and drug-resistance profiles of pathogens in ICU could provide evidence for the control of nosocomial infection and anti-infection therapy.