ICU呼吸道标本病原菌分布及耐药性分析

Distribution and drug resistance of pathogenic bacteria from respiratory tract specimens in ICU

目的探讨重症监护病房(ICU)患者呼吸道病原菌感染的分布和耐药趋势,为临床控制感染和合理用药提供依据。方法回顾性分析2015年1月—2017年12月上海长征医院ICU呼吸道标本分离出的1 427株病原菌,采用VITEK 2 Compact全自动微生物鉴定及药敏分析系统进行病原菌鉴定,采用K-B法和MIC法进行药敏试验,观察结果并分析。结果革兰阴性(G-)菌是ICU呼吸道感染的最主要菌型,构成比前3位依次为鲍曼不动杆菌(27.82%)、铜绿假单胞菌(18.71%)和肺炎克雷伯菌(16.82%),其中肺炎克雷伯菌对亚胺培南和美罗培南的耐药率均>50%,仅对阿米卡星的耐药率<40%;鲍曼不动杆菌对绝大多数抗菌药物的耐药率极高(>80%),而对头孢哌酮/舒巴坦(44.58%)和米诺环素(39.04%)的耐药率较低;铜绿假单胞菌对亚胺培南(46.82%)和美罗培南(39.70%)的耐药率较高,对阿米卡星的耐药率最低(12.36%)。革兰阳性(G+)菌以金黄色葡萄球菌多见,其中耐甲氧西林金黄色葡萄球菌(MRSA)的耐药率(81.58%)明显高于甲氧西林敏感金黄色葡萄球菌(MSSA,18.42%)。结论 ICU呼吸道标本病原菌的耐药率较高,建议临床加强多重耐药菌监测和抗菌药物使用管理,针对药敏结果选用敏感性强的抗菌药物。

Objective To investigate the distribution and drug resistance trend of pathogenic bacteria from respiratory tract specimens of patients in intensive care unit(ICU) in order to provide evidence for clinical infection control and rational drug use. Methods A retrospective analysis was conducted;1 427 strains of pathogenic bacteria from respiratory tract specimens in ICU from January 2015 to December 2017 were selected, VITEK 2 Compact Full Automatic Microorganism Identification and Drug Sensitivity Analysis System were used to identify the pathogens, K-B method and MIC method were applied for drug sensitivity tests, and the results were observed and analyzed. Results Gram-negative(G-) bacteria were the most important pathogens of respiratory tract infections in ICU, of them, the proportions of the first 3 constituents were Bauman Acinetobacter(27.82%), Pseudomonas aeruginosa(18.71%) and Klebsiella pneumoniae(16.82%). The resistance rates of Klebsiella pneumoniae to imipenem and meropenem were all over 50%, only the resistance rate of amikacin was less than 40%;the resistance rate of Acinetobacter baumannii was extremely high to most antibiotics(> 80%), but the resistance rates to cefoperazone shubatan and minocycline were lower, 44.58% and 39.04% respectively;the resistance rates to imipenem and meropenem of Pseudomonas aeruginosa were higher, 46.82% and 39.70% respectively, and the resistance rate to amikacin was the lowest(12.36%). Staphylococcus aureus was the most common Gram-positive(G+) Pathogenic bacteria, of them, the resistance rates of methicillin resistant strains of Staphylococcus aureus(MRSA, 81.58%) were obviously higher than those of methicillin sensitive strains of Staphylococcus aureus(MSSA, 18.42%). Conclusions The drug resistance rates of pathogenic bacteria from respiratory tract specimens in ICU are relatively high. It is suggested to strengthen the monitoring of multidrug-resistant bacteria clinically, properly manage the use antimicrobial agents, and based on the results of drug sensitivity tests to choose antimicrobial agents with target pathogen high sensitivity.