综合性教学医院ICU病原菌分布及耐药性变迁

Distribution and drug resistance of pathogens in ICUs of a general teaching hospital

目的了解综合性教学医院ICU病原菌的分布及耐药性,为指导临床合理用药提供依据。方法回顾性分析2009年1月-2011年12月医院ICU住院患者送检标本中所分离的病原菌及其耐药性,采用法国生物梅里埃公司VITEK-2微生物分析系统进行细菌鉴定,药敏试验采用MIC稀释法,头孢西丁测定采用K-B法,结果按CLSI标准进行判定。结果 3年共检出病原菌4 166株,以革兰阴性菌为主占83.2%,革兰阳性菌占16.8%;革兰阴性菌中排前3位的依次为铜绿假单胞菌、嗜麦芽寡养单胞菌和鲍氏不动杆菌,分别占18.9%、16.3%和15.5%;革兰阳性菌以金黄色葡萄球菌、凝固酶阴性葡萄球菌、肠球菌属为主,分别占7.2%、5.6%和3.5%;肠杆菌科对碳青霉烯类的耐药性最低;产ESBLs肺炎克雷伯菌和大肠埃希菌分别为56.2%和75.6%;MRSA、MRCNS的检出率分别为100.0%和97.9%,葡萄球菌属和肠球菌属对万古霉素、替考拉宁、利奈唑胺的耐药性最低,对其他抗菌药物的耐药性较高。结论 ICU菌谱分布以革兰阴性菌为主,耐药性严重,且耐药率呈上升趋势,应依据药敏试验来选择用药。

OBJECTIVE To investigate the distribution and drug resistance of pathogens in the ICUs of the general teaching hospital so as to provide guidance for reasonable clinical use of antibiotics. METHODS The patients who were hospitalized the ICUs from Jan 2009 to Dec 2011 were enrolled in the study, then the distribution and drug resistance of pathogens isolated from the submitted specimens were retrospectively analyzed, then strains were identified by using VITEK-2 microorganism analysis system of BioM6rieux, France; the drug susceptibility testing was performed with the use of MIC dilution method, the cefoxitin test was carried out by using K-B method, and the results were interpreted according to the criteria of CLSI. RESULTS A total of 4 166 strains of pathogens have been isolated, among which the gram-negative bacteria accounted for 83.2 %, the gram-positive bacteria 16.8%; the Pseudomonas aeruginosa , Stenotrophomonas maltophilia , and Acinetobacter baumannii ranked the top three species of gram-negative bacteria, accounting for 18.9%, 16.3%, and 15.5%, respectively; the Staphylococcus aureus, coagulase-negative Staphylococcus, and Enterococcus were the predominant species of gram-positive bacteria, accounting for 7.2 %, 5.6%, and 3.5%, respectively. The drug resistance rate of the Enterobacterlaceae to carbapenerns was the lowest, the ESBLs-producing Klebsiella pneumoniae56.2 %, the ESBLs-producing Escherichia coli75.6%. The isolation rate of MRSA was 100.0%, MRCNS 97.9%. The drug resistance rates of the Staphylococcus and Enterococcus to vancomycin, teicoplanin, and linezolid were the lowest, but the strains were highly resistant to other antibiotics. CONCLUSION The gram-negative bacteria are the predominant pathogens in the ICUs and are highly drug-resistant; the drug resistance rates show an upward trend. It is necessary to use antibiotics based on the results of the drug susceptibility testing.