我院2013年内科ICU革兰阴性菌的分布及耐药性分析

The distribution and drug resistance analysis of gram-negative bacteria in internal medicine ICU in 2013

目的通过对我院内科ICU住院患者革兰阴性菌的分布及耐药性分析,以指导临床合理应用抗菌药物。方法回顾性分析我院2013年内科ICU住院患者送检标本检出病原菌的分布情况,应用ATB-Expression半自动微生物系统及配套进行菌株鉴定与药物敏感性测定,并用WHONET5.5软件进行数据统计分析。结果我院2013年内科ICU住院患者送检标本中检出革兰阴性菌共759株,分别为鲍曼不动杆菌(33.3%)、铜绿假单胞菌(17.4%)、大肠埃希菌(16.7%)、肺炎克雷伯菌(10.8%)、肠球菌(7.7%)、凝固酶阴性葡萄球菌(6.9%)、阴沟肠杆菌(4.2%)及嗜麦芽窄食单胞菌(2.8%)。耐药性分析显示,鲍曼不动杆菌对头孢哌酮/舒巴坦耐药率最低(48.2%),对碳青霉烯类的耐药率高达90%以上;铜绿假单胞菌对磺胺甲唑耐药率最高(100%);大肠埃希菌对环丙沙星、左氧氟沙星、哌拉西林耐药率均达80%以上,但对碳青霉烯类保持较高的敏感性(100%);碳青霉烯类、阿米卡星和头孢哌酮/舒巴坦对肺炎克雷伯菌保持较强的抗菌活性。结论鲍曼不动杆菌的耐药性最为严峻,仅对头孢哌酮/舒巴坦相对敏感;阿米卡星、碳青霉烯类和头孢哌酮/舒巴坦对铜绿假单胞菌、大肠埃希菌及肺炎克雷伯菌保持有较强的抗菌活性。

Objective To analyze the distribution and drug resistance of gram-negative bacteria in internal medicine ICU, to guide clinical rational use of antibiotics. Methods Retrospectively analyzed the distribution of gram-negative bacteria in internal medicine ICU, and determined identification and drug sensitivity by ATB-Expression semi-automatic microbial sys- tem. All data were analyzed by WHONET 5.5 statistical software. Results 759 strains of gram-negative bacteria were detect- ed. There were Acinetobacterbaumannii （33.3%）, Pseudomonas aeruginosa （17.4%）, Escherichia call （16.7%）, Klebsiellap- neumoniae （10.8%）, Enterococcus （7.7%）, Coagulase negative staphylococcus （6.9%）, Enterobacter cloacae （4.2%）, and Stenotrophomonasmaltophilia bacteria （2.8%） respectively. Drug resistance analysis showed that Acinetobacterbaumannii resistant to cefoperazone/sulbactam was the lowest （48.2%）, but the rate resisted to carbapenems was more than 90% to sulfamethoxa- zole, the drug resistant rate of Pseudomonas aeruginosa was 100%; the rate of Eschericbia coli resisted to ciprofloxacin, lev- ofloxacin and piperacillin were above 80%, but maintained a higher susceptibility to carbapenems （100%）. Carbapenems, amikacin and cefoperazone / sulbactam maintained strong antibacterial activity against Klebsiella, for the first choice of clinic. Conclusion The drug resistance of Acinetobacterbaumannii is the most severe, only cefoperazone/sulbactam is relatively sensi- tive to it. Amikacin, carbapenems and cefoperazone/sulbactam maintain strong antibacterial activity against Pseudomonas bacte- ria, Escherichia coli and Klebsiella pneumoniae.