基于耐药基因分析急诊重症监护病房优势病原菌耐药特性

Analysis of Drug Resistance Characteristics of the Dominant Pathogenic Bacteria in Emergency Intensive Care Unit Based on the Drug Resistance Gene

目的了解2014年首都医科大学附属北京中医医院急诊重症监护病房(EICU)的病原菌分布特点及耐药性,分析优势菌相关耐药基因的表达,为临床治疗提供依据。方法搜集2014年首都医科大学附属北京中医医院EICU的所有送检标本226例,分离并培养菌株;以COMPACT VITEK-2全自动微生物鉴定系统鉴定菌种并检测优势菌种的耐药性;以聚合酶链反应法检测鲍曼不动杆菌耐药基因TEM表达情况。结果 226例送检标本中共分离出病原菌214株。其中,革兰阳性菌79株(36.92%),以金黄色葡萄球菌和屎肠球菌居多;革兰阴性菌135株(63.08%),以鲍曼不动杆菌、大肠埃希菌和铜绿假单胞菌居多。金黄色葡萄球菌对利奈唑胺、万古霉素和呋喃妥因敏感性较好,无耐药菌株检出;鲍曼不动杆菌对阿米卡星较敏感,耐药率<20%,对其他19种抗生素的耐药率均>50%。鲍曼不动杆菌TEM基因表达率为100%。结论 EICU感染的病原菌以革兰阴性菌为主,优势革兰阴性菌株鲍曼不动杆菌的耐药率较高。

Objective To investigate the distribution characteristics and drug resistance of pathogenic bacteria in the emergency intensive care unit（ EICU） of Beijing TCM Hospital affiliated to the Capital Medical University in 2014,and to analyze the expressions of related drug resistance genes of the dominant pathogenic bacteria so as to provide reference for the clinical treatment. Methods A total of 226 samples from EICU in 2014 were collected,and then the pathogenic bacteria were isolated and cultured. The types were identified,and the drug resistance of dominant pathogenic bacteria were detected by COMPACT VITEK-2 automatic microbiological assay system. The drug resistance gene TEM expression of acinetobacter baumannii was detected with polymerase chain reaction method. Results A total of 214 pathogenic bacteria were isolated from the 226 samples. There were 79 strains（ 36. 92%） of gram positive bacteria,and staphylococcus aureus and streptococcus were on the top; 135 strains（ 63. 08%） of gram negative bacteria mainly were Bauman acinetobacter,escherichia coli and pseudomonas aeruginosa. Staphylococcus aureus was sensitive against Linezolid,Vancomycin and Nitrofurantoin,and no resistant strains were found; Bauman acinetobacter was sensitive against Amikacin,and the drug resistance rate was less than 20%,and the drug resistance rates against the other 19 antimicrobial agents were over 50%. The TEM gene expression rate of Bauman acinetobacter was 100%. Conclusion The dominant pathogenic bacteria in EICU infection are mostly the gram negative bacteria and Bauman acintobacter with a high drug resistance rate.