呼吸重症监护病房2012年病原微生物结果及耐药性分析

Pathogen distribution and antibiotic resistance in respiratory intensive care unit in 2012

目的了解中南大学湘雅医院呼吸重症监护室(RICU)病原微生物感染及耐药情况,以期对临床用药及控制感染提供指导意义。方法回顾性分析中南大学湘雅医院RICU 2012年1月-2012年12月住院患者痰培养的药敏试验阳性结果。结果痰培养共分离出397株细菌,感染前三位分别为鲍曼不动杆菌40.05%(159/397)、铜绿假单胞菌19.14%(76/397)、金黄色葡萄球菌9.57%(38/397)。鲍曼不动杆菌、铜绿假单胞菌及金黄色葡萄球菌的耐药情况严重。鲍曼不动杆菌除对头孢哌酮舒巴坦(27.04%)和阿米卡星(25.79%)的耐药率较低外,对其他抗生素都高度耐药,耐药率超过80%。铜绿假单胞菌对β-内酰胺类、氨基糖苷类抗菌药物耐药性高。真菌耐药罕见。结论 RICU痰培养致病细菌以鲍曼不动杆菌为代表的革兰阴性杆菌为主,革兰阳性菌中金黄色葡萄球菌感染居首,真菌感染比例较高。主要的致病细菌耐药性较高,且出现耐多种药物。

[Objective] To investigate distribution and antibiotic resistance of pathogens in Department of Respi- ratory Medicine Intensive Care Unit （RICU） of Xiangya Hospital andprovide the reasonable anti-infectious strategy and guidance for clinical drug using. [Methods] Bacterial susceptibility testing from sputum culture isolated from in-patients in RICU of Xiangya Hospital from January 2012 to December 2012 was retrospectively analyzed. IRe- suits] Totally 397 strains of pathogens were isolated from sputum specimens in RICU of Xiangya hospital in 2012. The major three pathogens are Acinetobacter baumannii consisting of 40.05%（159/397）, Pseudomonas aeruginosa consisting of 19.14%（76/397）, Staphylococcus aureus consisting of 9.57%（38/397）. The drug-resistance of Acineto- bacter baumannii, Pseudomonas aeruginosa and Staphylococcus aureus is quite serious. Only about 27.04% and 25.79% of Acinetobacter baumannii strains were resistant to cefoperazone/sulbactam and Amikacin. But Acinetobac- ter baumannii was highly resistant to other antibiotics, the drug-resistant rate was over 80%. Pseudomonas aerugi- nosa have high drug resistant to beta lactam and aminoglycoside antibiotics. Drug-resistantto fungal was rare. [ Conclusions ] Gram-negative bacilli were the major pathogens of RICU and Acinetobacter baumannii was the rep- resentive pathogens. The mainly gram-positive pathogens was staphylococcus aureus. Fungal infection rate was high. Drug resistant rate of the main pathogens was very high and multiple-drug resistant pathogens were emerging.