2008-2011年ICU医院感染目标监测细菌检出及药敏分析

Detection of target bacteria of nosocomial infection monitoring in ICU and drug sensitivity analysis from year 2008 to 2011

目的了解2008-2011年来源于ICU患者主要目标监测菌的检出及对抗菌药物的耐药变迁,为有效预防与控制ICU医院感染提供依据。方法近4年对ICU医院感染铜绿假单胞菌、鲍氏不动杆菌、耐甲氧西林金黄色葡萄球菌(MRSA)、耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)、超广谱β-内酰胺酶(ESBLs)、耐万古霉素肠球菌(VRE)、耐碳青烯类肠杆菌(CRE)等主要目标监测菌的检出及耐药性进行回顾性分析。结果共6129株菌主要来源于痰液、尿液、血液,分别占56.32%、21.94%、10.74%;4年中金黄色葡萄球菌中MRSA检出率分别为78.99%、46.67%、52.17%、54.17%;凝固酶阴性葡萄球菌中MRCNS的发生率为94.12%、88.89%、81.25%、75.00%;金黄色葡萄球菌与凝固酶阴性葡萄球菌对利福平、四环素、红霉素、氨苄西林/舒巴坦、磺胺甲噁唑/甲氧苄啶的敏感性差异有统计学意义(P<0.01);VRE检出率4年差异不明显;肠杆菌科产ESBLs的检出率为43.05%,对碳青霉烯类、氨基糖苷类、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢西丁均有较好的敏感性;鲍氏不动杆菌对多黏菌素的敏感率最高为100.00%,泛耐药鲍氏不动杆菌(PDRAB)平均检出率为36.81%;铜绿假单胞菌对多黏菌素的不敏感率最低,对亚胺培南和美罗培南的敏感率由67.9%下降至36.2%;泛耐药铜绿假单胞菌(PDRPA)检出率平均为8.09%,耐碳青酶烯类肠杆菌(CRE)共检出5株,其改良Hodge试验阳性及NDM-1表型初筛试验为阴性。结论 4年ICU主要目标菌检出率及耐药性比较严重,对碳青霉烯类抗菌药物耐药上升较快,连续监测主要目标菌的耐药变迁,及时进行医院控制干预,对临床具有十分重要的意义。

OBJECTIVE To investigate detection of the main target bacteria of nosocomial infection monitoring in ICU in 2008-2011 and changes in antimicrobial resistance, so as to provide reference for effective prevention and control of nosocomial infection in ICU. METHODS The drug resistance and detection of the main target monitoring bacteria that led to nosocomial infection in ICU during the recent four year were analyzed retrospectively, including Pseudornonas aeruginosa , Acinetobacter baumannii , methicillin-resistant Staphylococcus aureus （MRSA） , methi-cillin-resistant eoagulase-negative Staphylococcus （MRCNS）, extended-spectrum β-1actamase （β-ESBLs）, vanco- mycin-resistant Enterococcus bacteria （VRE）, and carbapenem-resistant Enterobacteriaceae （CRE）. RESULTS A total of 6129 sicrains were mainly isolated from sputum, urine, and blood, accounting for 56.32%, 21.94%, and 10.74 %, respectively. The detection rates of MRSA were 78.99%, 46.67%, 52.17%, and 54.17% and the detection rates of MRCNS were 94.12%, 88.89%, 81.25%, and 75.00% in each year, respectively. It showed significantly differences （P〈0.01） for Staphylococcus aureus and coagulase-negative Staphylococci in sensitivity to rifampicin, tetracycline, erythromycin, ampicillin/sulbactam, and cotrimoxazole. The VRE incidence was about 3.09% （ 15/485 ）, its incidence was not significantly different （ P 〉 0. 05 ） in four years. The Enterobacteriaceae ESBL-producing rate was 43. 05%, with good sensitivity to various drugs including carbapenems, aminoglyco-sides, piperacillin/tazobactam, cefoperazone/sulbactam and cefoxitin, polymyxin B showed the highest susceptibil-ity rate （100.00 % ） against A. baumannii, followed by minocycline （95.5 - 79.2 % ）. The average incidence of pan-resistant A. baurnannii （PDRAB） was 36.81% （544/1478）. Polymyxin B also showed the lowest non-susceptibili-ty rate against P. aeruginosa. Its sensitivity to imipenem and meropenem was reduced from 67.9% to 36.2%. The average detection rate of pan-resistant P. aeruginosa （PDR-PA） was 8.09%. A total of five strains of carbap- enem-resistant Enterobacteriaceae （CRE） were detected whose modified Hodge test and NDM-1 phenotype prelim- inary screening test were both positive. CONCLUSION There is a serious situation regarding to the detection rate and drug resistance of the main target bacteria in ICU in the past four years, especially for carbapenems whose resistance is increased rapidly. Continuous monitoring of resistance changes of the main target bacteria and timely hospital control intervention on clinical have very important significance.