外科ICU院内感染的病原菌及其耐药性分析

Distribution and antibiotic resistance of pathogens causing nosocomial infection for patients in surgery intensive care unit

目的了解外科ICU内引起院内感染的主要病原菌及其耐药性,为临床合理用药提供依据。方法回顾性分析中山大学附属第三医院2010年1月至2014年5月确定为ICU院内感染137例患者的感染病原菌及其耐药性。结果 137例患者中分离出感染病原菌223株。病原菌中革兰阴性杆菌最多,为120株,占53.8%,前三位分别为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌;革兰阳性球菌41株,占18.4%,前三位分别为金黄色葡萄球菌、屎肠球菌、溶血葡萄球菌;真菌62株,占27.8%,前三位分别为白色念珠菌、光滑念珠菌、季也蒙假丝酵母菌。耐药性结果显示革兰阴性杆菌耐药性鲍曼不动杆菌呈现多重耐药或泛耐药趋势,铜绿假单胞菌对碳青霉烯类药物的耐药性普遍升高,而敏感性降低,肺炎克雷伯菌表现了相对于鲍曼不动杆菌及铜绿假单胞菌较好的敏感性及较低的耐药性。阳性菌菌株及真菌菌株对药物的敏感性下降,耐药性上升,但目前尚未发现对万古霉素及利奈唑胺耐药的阳性菌株及对两性霉素B耐药的真菌菌株。结论该ICU的院内感染中以革兰阴性杆菌为主,鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌为主要构成菌,耐甲氧西林金黄色葡萄球菌(MRSA)和真菌的感染比例也较高,且耐药性严重。

Objective To ascertain the distribution and antibiotic resistance of pathogens causing nosocomial infection of patients in surgery intensive care unit （SICU）, aiming to provide evidence for appro- priate clinical use of antibiotics. Methods Clinical data regarding the distribution and antibiotic resistance of pathogens causing nosocomial infection of 137 patients in SICU of the Third Affiliated Hospital of SUN Yat-sen University during Jan 2010 to May 2014 were retrospectively analyzed. Results A total of 223 infective strains were isolated from 137 patients. Isolated pathogens mainly consisted of 120 strains of gram-negative bacteria, accounting for 53.8% , mostly including Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae; Forty-one strains of gram-positive bacteria were detected with a proportion of 18. 4%, mainly in- cluding Staphylococcus aureu, Excrement enterococcus and staphylococcus haemolyticus; Sixty-two （27. 8% ） fungi strains, mainly consisted of Saccharomyces albicans, Candida mycoderma and C. guilliermondii. Drug sensitive test revealed that Acinetobaeter baumannii showed multi-drug- and pan-drug-resistance to antibiotics. The resistance rate of Pseudomonas aeruginosa to carbopenems was commonly elevated whereas the sensitivity was decreased. Compared with Acinetobacter baumannii and Pseudomonas aeruginosa, Klebsiella pneumonia had higher sensitivity and lower drug resistance. Gram-positive bacteria and fungi had lower sensitivity but higher resistance to antibiotics. However, no gram-positive bacteria were found to be resistant to vaneomycin and linezolid, and no fungi were resistant to amphotericin-B. Conclusions Nosocomial infection was mainly caused by gram-negative bacteria in SICU. Aeinetobaeter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae were the primary pathogens inducing nosocomical infection. The proportion between methiciUin-re- sistant Staphylococcus aureus （MRSA） and fungal infection were relatively high. The drug resistance of these bacteria was challenging.