重症监护病房病原菌分布及耐药性变迁

Trend in distribution and antibacterial resistance of pathogens in ICU

目的了解ICU病房病原菌分布及主要病原菌耐药性变迁,为指导危重患者抗菌药物的使用及减少医院感染提供依据。方法回顾性分析2011年-2013年ICU患者的阳性标本临床数据,采用SPSS 16.0软件进行统计分析。结果2011年-2013年ICU分离病原菌以革兰阴性菌为主,占69.7%,革兰阳性菌和真菌分别占15.2%和15.1%,主要细菌分布无明显变化;革兰阴性菌中前3位分别为鲍曼不动杆菌、铜绿假单胞菌和肺炎克雷伯菌,鲍曼不动杆菌对大部分抗菌药物耐药率>90%,仅对阿米卡星耐药率较低,为21.7%;革兰阳性菌中主要为葡萄球菌和屎肠球菌,葡萄球菌对苯唑西林耐药率极高,为91.2%,未发现万古霉素和替加环素耐药株;真菌中大部分为白色假丝酵母菌,其耐药率较低;各菌对部分抗菌药物耐药率有逐年下降趋势。结论建立完善的抗菌药物监测体系、合理使用抗菌药物、减少院内感染是降低细菌耐药性的重要手段。

Objective To study the trend of distribution and antibacterial resistance of pathogens in Intensive Care Unit （ ICU）, so as to provide the basis for the guidance of the use of antibiotics and the reduction of nosocomial infections. Methods The clinical data of all the isolated strains from patients in ICU from 2011 to 2013 were respectively analyzed. And SPSS 16.0 software was adopted to statistical analysis. Results The major infected pathogen in ICU from 2011 to 2013 was gram - negative bacteria, accounting for 69.7%, followed by the gram - positive bacteria and fungi, accounting for 15.2% and 15.1%, respectively, and the distribution of main pathogens had no obvious change. Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumonia were the top three among gram - negative bacteria. Acinetobacter baumannii presented high resistance to most of antibiotics, which were more than 90%, but only showed low resistance to amikacin, which was 21.7%. Staphylococci and Enterococcus Faecium were the major pathogens of the gram - positive bacteria. Staphylococci presented high resistance to oxacillin, which was 91.2%, and no vancomycin and tigecycline resistant pathogens were found. Candida Albicans was the predominant species of fungi and showed low resistance. Most bacteria statistically showed higher sensitivity to regular antibiotics （P 〈 0.05）. Conclusion The establishment of perfect drug monitoring system, the rational use of antibiotics and the control of hospital infection are the effective ways to reduce bacterial resistance.