重症监护室非发酵菌的耐药性分析及治疗策略

Intensive Care Unit of Fermentation Bacteria Resistance Analysis and Treatment Strategies

目的 探讨陕西省人民医院重症监护室非发酵菌的感染分布及其临床治疗策略.方法 回顾性分析陕西省人民医院201 2年1月～2013年12月期间重症监护室送检的3 850份标本经普通培养分离鉴定的非发酵菌,以MIC法进行药敏试验分析抗生素的耐药性.结果 3 850份标本分离出1 872株病原菌,其中革兰阳性细菌479株（占25.6％）,革兰阴性细菌1 393株（占74.4％）.在革兰阴性细菌中有732株（占52.5％）为非发酵菌,其中铜绿假单胞菌385株（占52.6％）,鲍曼不动杆菌209株（占28.6％）,嗜麦芽窄食单胞菌为114株（占15.6％）,其余非发酵菌24株（占3.2％）.非发酵菌对不同抗菌药物呈多重耐药性,其中铜绿假单胞菌对亚胺培南、头孢哌酮/舒巴坦的耐药率为31.7％和14.3％;鲍曼不动杆菌对头孢哌酮/舒巴坦、替加环素的耐药率为25.8％和1.5％,对其它抗生素如庆大霉素、哌拉西林、亚胺培南和美罗培南等的耐药率＞60％;嗜麦芽窄食单胞菌对米诺环素、复方新诺明的耐药率为1.0％和10.5％.在治疗非发酵菌感染时依据细菌的药敏结果单药治疗或联合治疗,总体治愈率＞80％,很大程度地降低了多重耐药菌在重症监护室的传播.结论 重症监护室非发酵菌的耐药性日趋严重,临床的抗感染治疗需要依据微生物室的敏感性报告;合理使用抗生素,以降低院内感染发生率和非发酵菌耐药率.

Objective To discuss the intensive care unit in Shaanxi Province People＇s Hospital of fermentation bacteria infection distribution and clinical treatment strategies.Methods Retrospective analysis in Shaanxi Province People＇s Hospital from January 2012 to December 2012,between the intensive care unit makes 3 850 specimens by ordinary train separation identification of fermentation bacteria,drug sensitive test in MIC analysis of antibiotic resistance.Results 3 850 specimens isolated 1 872 strains of pathogenic bacteria,including 479 strains gram-positive bacteria （25.6％）.1 393 strains of gramnegative bacteria （74.4％）.In 732 of gram-negative bacteria strains （52.5％） for the fermentation bacteria,of which 385 strains pseudomonas aeruginosa （52.6 ％）,209 strains of acinetobacter baumannii （28.6 ％）,stenotrophomonas maltophilia 114 strains （15.6％） and the rest of the 24 strains of fermentation bacteria （3.2％）.The fermentation bacteria to different antimicrobial agents in multiple drug resistance,including pseudomonas aeruginosa to cefoperazone/sulbactam resistant rate of 31.7％ and 14.3％ ;Acinetobacter baumannii to cefoperazone/sulbactam and tigecycline the resistant rate of 25.8％ and 1.5％,to other antibiotics such as gentamycin,piperacillin,imipenemi and meropenem percentages of greater than 60％; stenotrophomonas maltophilia of minocycline and trimesulf resistant rate of 1.0 ％ and 1.0 ％.In the treatment of fermentation bacteria infection according to the results of drug susceptibility of bacteria monotherapy or combination therapy,overall cure rate was more than 80％,greatly reduce the spread of multi-resistant bacteria in intensive care unit.Conclusion Intensive care unit of fermentation bacteria drug resistance has become increasingly serious,the clinical anti-infection treatment need to report on the basis of the sensitivity of the microbial chamber.The rational use of antibiotics,in order to reduce the incidence of nosocomial infection and the fermentation bacteria resistance.