重症监护室血行感染病原菌分布及耐药性分析

The microbiotic distribution and drug-resistant condition for blood infection in intensive care unit

目的:了解重症监护室(ICU)患者血行感染病原菌的分布情况及相关耐药性,为临床抗菌药物的选用提供科学依据。方法:采用回顾性调查分析的方法,收集深圳市人民医院ICU2010年1月-2012年12月血培养的结果,统计分析病原菌的分布及耐药情况。结果:1 819份血标本共分离出病原菌183株,阳性率10.06%。分离数量最多的前5位分别是鲍曼不动杆菌(AB)(22.95%),溶血葡萄球菌(11.48%),表皮葡萄球菌(9.3%),白色假丝酵母菌(7.65%)和大肠埃希菌(6.56%)。结论:ICU血行感染病原菌种类多样,病原菌对常用的抗菌药物产生了程度不等的耐药性。多耐药AB分离率最高,仅对米诺环素及头孢哌酮/舒巴坦保持较高的敏感性;其他的G-菌对碳青霉烯类药物及加酶抑制剂的抗生素仍保持高度敏感。对于MRS所致的感染,万古霉素、利奈唑胺可作为治疗的首选。

OBJECTIVE To overview the microbiotic distribution and drug-resistant condition for blood infection in intensive care unit （ICU）, so as to provide antibiotic selective rationale for clinical practice. METHODS Distribution and drug-resistant condition of pathogenic bacteria cultured from blood stream between Jan. 2010 and Dec. 2012 were reviewed. RESULTS 183 pathogens were detected from 1 819 blood samples with a positive rate of 10.06%. The first five pathogens were Acinetobacter baumannii （ AB） （22. 95%） , Staphylococcus haemolyticus （ 11.48 % ）, Staphylococcus epidermidis （9. 3% ）, Candida albi- cans （7.65%）, and Escherichia coli （6. 56%）. CONCLUSION Various pathogens caused blood stream infection in ICU, pathogens to commonly used antimicrobial agents produced varying degrees of resistance. Multidrug-resistant AB separation rate is highest, only maintaining high sensitivity to minocycline and cefoperazone/sulbactam. For other Gram negative bacteria, carbapenem and beta-lactamase inhibitors remain highly sensitive. For MRS, vancomycin and linezolid were still the first choices.