重症监护病房分离细菌的耐药性监测

Intensive care unit separation of bacteria drug resistance surveillance

目的 了解医院重症监护病房（ICU）病原菌的分布及耐药性,为临床合理用药和医院感染预防控制提供依据.方法 回顾性分析2009年1月至2012年12月医院ICU分离的749株病原菌的耐药性,细菌鉴定和药敏试验采用VITEK 2 Compact全自动细菌培养鉴定仪.结果 749株病原菌中以鲍曼不动杆菌（208株,27.8％）、铜绿假单胞菌（108株,14.4％）、大肠埃希菌（96株,12.8％）、金黄色葡萄球菌（76株,10.1％）、肺炎克雷伯菌（62株,8.3％）为主;标本来源主要为痰液（503株,67.2％）;耐甲氧西林金黄色葡萄球菌（MRSA）的分离率为82.9％ （63/76）;耐亚胺培南铜绿假单胞菌（IRPA）的分离率为22.2％（24/108）;耐碳青霉烯类抗菌药物鲍曼不动杆菌（CR-AB）的分离率为88.0％ （183/208）.鲍曼不动杆菌对阿米卡星耐药率为28.6％～ 31.5％,对其它20种抗菌药物的耐药率高达81.6％～100.0％;铜绿假单胞菌对环丙沙星、左氧氟沙星、氨曲南和哌拉西林/他唑巴坦的耐药率为11.6％ ～25.0％.结论 ICU检出的病原菌中,多药耐药的现象严重,医院应加强细菌耐药性监测,合理使用抗菌药物,降低医院感染.

Objective To understand the hospital intensive care unit（ICU） pathogenic bacteria distribution and drug resistance for providing the basis for rational drug use and hospital infection control and prevention.Methods The drug resistance of 749 strains of pathogenic bacteria the separated from ICU was analyzed from January 2009 to December 2012.VITEK 2 Compact automatic bacteria identification instrument was used to detect bacteria identification and drug sensitive test using.Results There were Acinetobacter baumannii（208 strains,27.8%）,Pseudomonas aeruginosa（108 strains,14.4%）,E.coli （96 strains,12.8 %）,Staphylococcus aureus （76 strains,10.1%）,Klebsiella pneumoniae（62 strains,8.3%） mainly accupied in 749 strains of pathogenic bacteria.The species was mainly from sputum specimens sources （503 strains,67.2%） ; the separation rate of Methicillin-resistant staphylococcus aureus （MRSA） was 82.9% （63/76） ; the separation rate of Imine resistance from South pseudomonas aeruginosa（IRPA） was 22.2% （24/108） ; the separation rate of resistance to carbon penicillium alkene antimicrobial acinetobacter baumannii （CR-AB） was 88.0% （183/208）.The resistant rate of Acinetobacter baumannii to amikacin was from 28.6% to 31.5%,the other 20 kinds of antimicrobial drug resistant rate was as high as 81.6%-100.0% ; Pseudomonas aeruginosa to ciprofloxacin,ofloxacin,aztreonam and piperacillin/tazobactam resistant rate of 11.6%-25.0%.Conclusion Detection of pathogens in ICU,multi-drug resistance is serious,the hospital should strengthen the bacterial drug resistance monitoring,rational use of antimicrobial drugs,reduce the nosocomial infection.