ICU住院患者感染病原菌分布及耐药性分析

Distribution and drug resistance of pathogens causing infections in hospitalized patients of ICU

目的分析ICU住院患者感染病原菌分布及耐药性,为抗菌药物的合理应用提供依据。方法选取2013年1月-2016年5月医院ICU住院的72例感染患者,进行细菌分离及鉴定,并分析感染患者的病原菌分布及药敏试验结果。结果 ICU住院的72例感染患者的感染部位以呼吸道、泌尿道、消化道为主,分别占56.9%、26.4%和15.3%,标本来源以痰液、尿液、血液为主,分别占52.7%、27.5%和18.7%;共分离病原菌91株,其中革兰阴性菌55株占60.4%,革兰阳性菌34株占37.4%,真菌2株占2.2%;革兰阴性菌中大肠埃希菌和肺炎克雷伯菌检出率较高,分别为30.8%和16.5%,革兰阳性菌中肠球菌属和金黄色葡萄球菌检出率较高,分别为22.0%和9.9%,真菌中白假丝酵母菌占2.2%;革兰阴性菌对氨基糖苷类、喹诺酮类、第三代头孢菌素等抗菌药物耐药率较高,部分可达100.0%,而对美罗培南、亚胺培南、阿米卡星及头孢哌酮/舒巴坦等仍较敏感,革兰阳性菌对青霉素、克林霉素等普遍耐药,但对万古霉素、替考拉宁、利福平等仍较敏感。结论 ICU住院患者发生感染以呼吸道感染最为常见,泌尿系感染次之;在分离菌株中仍以革兰阴性菌为主,对美罗培南、亚胺培南、阿米卡星及头孢哌酮/舒巴坦等抗菌药物仍较敏感,可以为临床医师的经验性用药提供依据。

OBJECTIVE To investigate the distribution and drug resistance of pathogens causing infections in hospitalized patients of ICU so as to provide guidance for reasonable use of antibiotics.METHODS A total of 72 patients with infections who were hospitalized ICU from Jan 2013 to May 2016 were enrolled in the study,then the pathogens were isolated and identified,the distribution of the pathogens isolated from the patients with infection was observed,and the result of drug susceptibility testing was analyzed.RESULTS Of the 72 hospitalized patients with infections in ICU,56.9% had respiratory tract infection,26.4% had urinary tract infection,and 15.3% had gastrointestinal tract infection.The sputum,urine,and blood were the major specimen sources,accounting for52.7%,27.5%,and 18.7%,respectively.Totally 91 strains of pathogens were isolated,including 55（60.4%）strains of gram-negative bacteria,34（37.4%）strains of gram-positive bacteria,and 2（2.2%）strains of fungi.Among the gram-negative bacteria,the isolation rates of Escherichia coli and Klebsiella pneumoniae were 30.8%and 16.5%,respectively.Among the gram-positive bacteria,the isolation rates of Enterococcus sppand Staphylococcus aureus were 22.0% and 9.9%,respectively;Candida albicans accounted for 2.2% among the fungi.The gram-negative bacteria were highly resistant to aminoglycosides,quinoilones,and third generation cephalosporins,the drug resistance rate to some of the antibiotics reached 100.0%,however,the strains maintained highly susceptible to meropenem,imipenem,amikacin,and cefoperazone-sulbactam.The gram-positive bacteria were generally resistant to penicillin and clindamycin but were still sensitive to vancomycin,teicoplanin,and rifampicin.CONCLUSIONThe respiratory tract infection is the most common among the hospitalized patients with infections in ICU,followed by urinary system infection.The gram-negative bacteria are dominant among the isolated pathogens;the strains maintain highly susceptible to meropenem,imipenem,amikacin,and cefoperazone-sulbactam,which may provide guidance for empirical use of antibiotics.