ICU病房细菌感染的流行病学和耐药性分析

Epidemiology and Antibiotic Resistance of Bacteria in Intensive Care Unit

目的 动态监测ICU主要病原性细菌的流行病学分布及耐药性情况,以指导合理使用抗生素,为临床抗感染治疗提供依据.方法 对武汉大学中南医院ICU病房2008年1月～2010年12月住院患者的所有送检标本常规进行病原菌培养与鉴定,药敏试验采用K-B纸片琼脂扩散法,将所有结果录入WHONET5.4软件进行统计和耐药性分析.结果 2008 ～2010年我院病房ICU共分离病原菌1809株,其中G＋菌386株,占21.3％;G-菌1423株,占78.7％.分离前五位的细菌依次为：铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌、金黄色葡萄球菌、嗜麦芽窄食单胞菌.非发酵菌检出株数增加,铜绿假单胞菌及鲍曼不动杆菌占细菌总数的42.3％.产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌检出率分别为86.9％和62.7％;MRSA占金葡菌的86.7％,尚未分离出耐万古霉素的葡萄球菌,在G-菌中耐药率最低的药物是头孢哌酮/舒巴坦和碳青霉烯类,G＋菌中耐药率最低的是万古霉素和替考拉宁.结论 ICU病房是发生细菌感染的重灾区,细菌耐药显著,了解其细菌分布并动态监测其耐药性,可为合理使用抗生素提供依据,从而减缓耐药性的发生.

Objective To monitor the epidemiology and antibiotic resistance of bacteria in intensive care unit （ICU） dynamically for rational use of antibiotics and provide basis for anti - infective treatment. Methods All speci- mens in ICU, Zhongnan Hospital of Wuhan University were cultured and identified from Jan. 2008 to Dec. 2010. K - B disk agar diffusion method was used in drug sensitivity test. All results were input to WHONET5.4 software for statis- tics and drug resistance analysis. Results A total of 1809 strains were isolated from 2008 to 2010,among which 386 （2l. 3% ）were G- positive bacteria, 1423 were G- negative bacteria（78.7% ）. The top five pathogens were pseudo- monas aeruginosa, acinetobacter baumannii, E. coli, staphylococcus aureus and stenotrophomonas maltophilia. Nonfer- menters that increased for 42.3% of the bacteria were pseudomonas aeruginosa and acinetobacter baumannii. Detec- tion rates of ESBLs producing E. coli and klebsiella pneumonia were 86.9% and 62.7%. 86.7% of staphylococcus aureus were methicillin - resistant staphylococcus aureus （MRSA）. Vancomycin - resistant staphylococcus was not separated. Resistance rates to cefoperazone/sulbactam and carbapenems were the lowest among G - negative bacteria. Resistant rates to vancomycin and teicoplanin were the lowest among G - positive bacteria. Conclusion ICU is the hardest - hit area of bacteria infection,in which antibiotic resistance is significant. Dynamic monitoring the epidemiolo- gy and antibiotic resistance of bacteria can provide the basis for rational use of antibiotics, and slow down the occur- rence of antibiotic resistance.