我院重症医学科耐药细菌分布及耐药性分析

Distribution of drug-resistant bacteria and drug resistance analysis in ICU patients of the second-level hospital

目的了解该院重症医学科住院患者感染病原菌分布及耐药情况,为指导临床科室合理使用抗菌药物,减少耐药性的发生提供依据。方法收集2014-2015年该院重症医学科住院患者采集的各类标本,对检出的病原菌分布及细菌耐药性进行回顾性分析。结果 2年间送检标本1 684份,分离出病原菌1 156株,细菌检出阳性率为68.65%。在分离菌株中革兰氏阴性菌897株,占77.60%;革兰氏阳性菌125株,占10.81%;真菌134株,占11.59%。其中感染的优势菌为肺炎克雷伯杆菌、鲍曼不动杆菌、铜绿假单胞菌,分别占到检出细菌的20.8%、15.1%和15.0%。肺炎克雷伯杆菌对氨苄西林的耐药率最高为97.5%,铜绿假单胞菌对喹诺酮类药物左氧氟沙星和环丙沙星的耐药率分别为48.0%和41.7%;鲍曼不动杆菌对美罗培南、头孢曲松、头孢他啶、环丙沙星和哌拉西林他唑巴坦的耐药率均超过了70.0%。结论该院重症医学科患者感染细菌以革兰氏阴性杆菌为主,耐药率较高,特别是鲍曼不动杆菌对多种抗菌药物耐药,要引起重视。应进一步加强预防和控制,建立细菌耐药监测制度和规范抗菌药物使用,减少细菌耐药性的发生。

Objective To investigate the distribution and drug-resistant tendency of pathogens in the ICU patients of the second-class hospital and to provide the guidance for rational use of antimicrobials in clinic. Methods Various types of specimens of ICU patients were colletted from the third people's hospital of Hechi city during January2014 to December 2015. The distribution and drug resistance of the pathogenic bacteria isolated from the specimens were retrospectively analyzed. Results A total of 1 156 strains of pathogenic bacteria were isolated from 1 684 specimens with a positive rate of 68. 65%. In all the isolated strains,877 strains were Gram-negative bacteria( 77. 6%),125 strains were Gram-positive bacteria( 10. 81%) and 134 strains were fungus( 11. 59%). The main pathogenic bacteria were Klebsiella pneumoniae( 20. 08%),Acinetobacter baumanii( 15. 1%),and Pseudomonas aeruginosa( 15. 0%). The drug resistance of Klebsiella pneumoniae to Ampicillin was 97. 5%. The drug resistances of Pseudomonas aeruginosa to Levofloxacin and Ciprofloxacin were 48. 0% and 41. 7% respectively. The drug resistances of Acinetobacter baumanii to Meropenem,Ceftriaxone,Ceftazidime,Ciprofloxacin and Piperacilin-Tazobactam were more than 70. 0%. Conclusion Gram-negtive bacteria are the major pathogens in ICU patients of the second-level hospital,which are multi-drug resistant. Acinetobacter baumanii is common in ICU and resistant to many species of anti-bacterials,which should be paid more attention in clinics.