2009—2013年某院重症监护病房常见细菌及耐药变迁

Common bacteria and change in antimicrobial resistance in the intensive care unit of a hospital from 2009 to 2013

目的 了解重症监护病房（ICU）近5年检出的常见细菌及其耐药性变迁,为临床合理用药提供依据。方法 收集某三甲医院2009—2013年ICU患者送检标本分离的细菌,对其进行鉴定及药物敏感试验。结果 2009—2013年ICU共分离细菌1 196株,居前5位的细菌为鲍曼不动杆菌、铜绿假单胞菌、金黄色葡萄球菌、大肠埃希菌、肺炎克雷伯菌,分别占29.60%、14.38%、12.21%、12.21%、11.37%。2009—2013年金黄色葡萄球菌对苯唑西林、庆大霉素、克林霉素、环丙沙星和利福平耐药率呈逐年下降趋势（均P〈0.05）,5年未出现对万古霉素耐药的菌株;铜绿假单胞菌对头孢他啶、头孢吡肟、氨曲南、庆大霉素、阿米卡星、妥布霉素和哌拉西林/他唑巴坦的耐药率呈下降趋势（均P〈0.05）,2009—2012年亚胺培南耐药率为32.26%~46.43%,2013年为16.00%;鲍曼不动杆菌对阿米卡星、妥布霉素和复方磺胺甲口恶唑的耐药率均呈下降趋势（均P〈0.05）,2009—2011年阿米卡星耐药率均〉80%,2013年则为10.53%,5年间鲍曼不动杆菌对大部分抗菌药物具有较高的耐药性（耐药率〉80%）。2009—2013年肺炎克雷伯菌、大肠埃希菌对哌拉西林/他唑巴坦、头孢唑林、头孢吡肟、阿米卡星和氨曲南等的耐药率呈下降趋势（均P〈0.05）。结论 该院ICU常见感染细菌对部分抗菌药物耐药性呈下降趋势,可能与国家政策的出台和医院的管理有关,建议继续加强抗菌药物管理,合理使用抗菌药物,防止细菌耐药性增加。

Objective To investigate the common bacteria and change in antimicrobial resistance in an intensive care unit （ICU）in the past 5 years,and provide evidence for rational use of antimicrobial agents.Methods Bacteria isolated from ICU patients in a tertiary first-class hospital from 2009 to 2013 were collected,identified,and per-formed antimicrobial susceptibility testing.Results A total of 1 196 bacteria isolates were isolated in 2009-2013, the top five species were Acinetobacter baumannii （A.baumannii,29.60%）,Pseudomonas aeruginosa （P . aeruginosa,14.38%）,Staphylococcus aureus （S .aureus ,12.21 %）,Escherichia coli （E.coli,12.21 %）,and Klebsiella pneumoniae （K .pneumoniae ,11 .37%）.Resistance rates of S .aureus to oxacillin,gentamycin, clindamycim,ciprofloxacin,and rifampicin showed a decreasing tendency from 2009 to 2013（all P 〈0.05）,and no strain was detected to be resistant to vancomycin during 5 years.Resistance rates of P .aeruginosa to ceftazidime, cefepime,aztreonam,gentamycin,amikacin,tobramycin,and piperacillin/tazobactam decreased gradually （all P 〈0.05）,imipenem resistance rates were 32.26% -46.43% in 2009 -2012 and 16.00% in 2013;A.baumannii maintained a low level resistance to amikacin,tobramycin,and compound sulfamethoxazole（all P 〈0.05）,resistance rates to imipenem were all 〉80% in 2009-2011 and 10.53% in 2013,A.baumannii had high resistance rates to most antimicrobial agents（resistance rates were 〉80%）during 5 years.Resistance rates of K .pneumoniae and E. coli to piperacillin/tazobactam,cefazolin,cefepime,amikacin,and aztreonam had a decreased tendency in 2009 -2013（all P 〈0.05）.Conclusion The common bacteria causing infection in the ICU of this hospital showed a down-ward trend,which may be related to the introduction of national policies and management of hospital,continuous management of antimicrobial agents is suggested,antimicrobial agents should be used rationally to prevent the in-crease of bacterial resistance.