3 238株致病革兰阴性杆菌在ICU和普通病房的耐药性差异分析

Differences in antibiotic resistance of 3 238 pathogenic gram-negative bacilli strains isolated in intensive care unit （ICU） and common wards

目的分析7种抗生素对重症监护病房（ICU）与普通病房分离的4种致病革兰阴性杆菌的耐药率差异。方法回顾性分析北京同仁医院2016年1至12月分离的3 238株革兰阴性杆菌耐药数据，其中重症组（ICU）分离菌株占比为46.6%，普通组（普通病房）为53.4%，分别检测两组分离菌株对7种抗生素的耐药性。结果重症组铜绿假单胞菌对头孢曲松、头孢吡肟和亚胺培南耐药率分别是41.7%、41.2%和39.5%，普通组这三种抗生素的耐药率分别是20.9%、21.7%和17.1%；重症组肺炎克雷伯菌对亚胺培南耐药率为17.2 %，普通组耐药率为8.8%；重症组大肠埃希菌对头孢曲松、头孢吡肟耐药率分别是72.9%和35.8%，普通组分别是44.7%和13.3%。重症组和普通组之间比较，铜绿假单胞菌对头孢曲松、头孢吡肟、亚胺培南耐药率差异大，差异均有统计学意义（χ^2头孢曲松＝56.72，P〈0.01；χ头孢吡肟2＝49.12，P〈0.01；χ^2亚胺培南＝69.81，P〈0.01）；肺炎克雷伯菌对亚胺培南耐药率差异大，差异有统计学意义（χ^2亚胺培南＝11.48，P〈0.01）；大肠埃希菌对头孢曲松、头孢吡肟耐药率差异大，差异均有统计学意义（χ^2头孢曲松＝40.13，P〈0.01；χ^2头孢吡肟＝41.61，P〈0.01）；鲍曼不动杆菌对7种抗生素耐药率均〉60%，重症组和普通组耐药率差异无统计学意义。结论与普通病房相比，ICU分离株耐药率更高，抗生素应该区别使用，定期监测耐药性，为诊断前的经验用药提供依据。

Objective To detect the antibiotic resistance of four kinds of gram-negative bacilli strains against seven antibiotics and to analyze the differences in antibiotic resistance between the strains isolated in intensive care unit （ICU） and common wards. Methods This study involved 3 238 gram-negative bacilli strains isolated in Beijing Tongren Hospital from January to December 2016. Of all strains, 46.6% were isolated in ICU （severe group） and 53.4% were isolated in common wards （general group）. Resist- ance of these strains to seven kinds of antibiotics was detected and the differences between the two groups were analyzed. Results Antibiotic resistance rates of Pseudomonas aeruginosa strains to ceftriaxone, cefepime and imipenem were 41.7% , 41.2% and 39.5% in severe group and 20.9%, 21.7% and 17.1% in general group. Moreover, the differences between the two groups were all statistically significant （ χ^2efatriaxone= 56.72, P〈0.01 ;χ^2Cefepime=49.12, P〈0.01 ; χ^2Imipnem= 69.81, P〈0.01 ）. Antibiotic resistance rates of Klebsiella pneumoniae strains to imipenem was 17.2% in severe group and 8.8% in general group, and the difference between the two groups was statistically significant （χ^2Imipenem= 11.48, P〈0.01 ）. Resistance rates of Escherichia coli strains to ceftriaxone and cefepime were 72.9% and 35.8% in severe group and 44.7% and 13.3% in general group, and the differences between the two groups were statistically sig- nificant （χ^2Ceftriaxone =40.13, P〈0.01 ; χ^2Cefepime =41.61, P〈0.01 ）. More than 60% ofAcinetobacter baumanii strains whether they were isolated in ICU or in common wards were resistant to all the seven antibiotics, and there were no significant differences between the two groups. Conclusion Gram-negative bacilli strains iso- lated in ICU have higher resistance rates than those isolated in common wards and therefore antibiotics shouht be used differently. Regular monitoring of drug resistance should be strengthened to provide references for empirical clinical medication.