我院ICU病房主要耐药菌的种类和有效防治措施探讨

The predominant strains of drug resistant bacteria in the ICU of the first people's hospital of Chun-an and the effective control measures

目的分析我院ICU病房抗生素使用情况和主要耐药菌种类,探讨有效防治耐药菌产生的措施。方法收集重症监护病房患者分泌物标本,分析标本菌群培养阳性菌株种类和耐药情况。结果我院ICU发生感染的流行菌株有铜绿假单胞菌(22.84%)、肺炎克雷伯菌(17.39%)、大肠埃希菌(14.64%)、鲍曼不动杆菌(10.99%)、金黄色葡萄球菌(7.34%)、以及白假丝酵母菌(12.21%)等,铜绿假单胞菌对碳青霉烯类、氨基糖苷类和三代、四代头孢类抗生素产生了一定的耐药性,肺炎克雷伯菌和大肠埃希菌对大多数抗生素敏感,金黄色葡萄球菌对万古霉素、替考拉宁等新兴G+抗生素比较敏感。结论我院ICU病房感染以G-细菌为主,G+细菌感染有上升的趋势,鲍曼不动杆菌、大肠埃希菌和肺炎克雷伯菌、铜绿假单胞菌对常见的头孢类等抗生素耐药性增高,在临床上治疗过程中应根据药物敏感试验结果选用合理的抗生素进行交替、周期性使用可有效防治细菌耐药性的产生。

Objective To obtain effective measures for deterring and containing the development of drug resistant bacteria in the ICU of the first people＇s hospital of Chun-an by conducting a close examination of the antibiotics usage and predominant strains of drug resistant bacteria developing in the unit. Method Firstly,specimens of the patients ＇secretion such as urine,sputum,blood,and feces were collected. The specimens of positive strains and their drug resistance were then analyzed. Findings The predominant strains bacteria that cause infectious diseases found in the ICU include pseudomonas aeruginosa（ 22. 84%）,klebsiella pneumoniae（ 17. 39%）,escherichia coli（ 14. 64%）,acinetobacter baumannii（ 10.99%）,golden yellow aureus（ 7. 34%） and candida albicans（ 12. 21%）,etc. Pseudomonas aeruginosa has fair resistance to carbapenems,aminoglycosides,and cephalosporins of the third generation and fourth generation. Klebsiella pneumoniae and Escherichia coli are sensitive to most antibiotics. The golden yellow aureus were sensitive to staphylococcus aureus,vancomycin, teicoplanin and other emerging G ＋ antibiotics. Conclusion Gram negative bacteria are the predominant bacteria found in the ICU of the first people＇s hospital of Chun-an. An increase in the number of G＋bacteriawas also found. Acinetobacter baumannii pneumonia of E. coli and Bacillus grams of klebsiella pneumoniae,pseudomonas aeruginosa had stronger resistance to the common cephalosporins antibiotics. Susceptibility-based and alternate use of antibiotics can provide an effective measure in preventing and controlling the development of the bacteria.