山东省101所医院重症监护病房患者分离细菌及耐药性特征

Bacteria and antimicrobial resistance features of bacteria isolated from patients in intensive care units in 101 hospitals in Shandong Province

目的了解山东省重症监护病房(ICU)细菌分布及耐药情况。方法收集2014年山东省101所医院ICU及106所医院普通病房(非ICU)分离细菌的药敏数据,进行统计分析。结果共收集细菌24 458株,革兰阴性菌占80.37%,革兰阳性菌占19.63%。ICU分离居前5位的细菌依次为:肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌、大肠埃希菌、金黄色葡萄球菌。来源于ICU的大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、黏质沙雷菌对碳青霉烯类药物、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、阿米卡星耐药率高于非ICU来源菌株(均P<0.01)。ICU分离鲍曼不动杆菌、铜绿假单胞菌、葡萄球菌属细菌对常用抗菌药物耐药率高于非ICU菌株(P<0.05)。ICU分离鲍曼不动杆菌对亚胺培南和美罗培南耐药率分别为78.0%、79.0%;铜绿假单胞菌对前述药物耐药率分别为25.5%、21.6%,对其他常用抗菌药物的耐药率<30.0%。ICU耐甲氧西林金黄色葡萄球菌(MRSA)检出率为39.7%,高于非ICU的26.0%(P<0.05)。结论 ICU分离细菌耐药情况比较严重,应依据药敏结果指导抗菌药物合理应用,防止耐药菌感染扩散。

ObjectiveTo investigate the distribution and antimicrobial resistance of bacteria isolates from intensive care units（ICUs） in Shandong Province.MethodsAntimicrobial susceptibility data about clinical strains isolated from ICUs of 101 hospitals and general wards（nonICUs） of 106 hospitals in Shandong Province in 2014 were analyzed statistically.ResultsA total of 24 458 strains of bacteria were isolated, of which gramnegative and grampositive bacteria accounted for 80.37% and 19.63% respectively.The top five pathogens in ICUs were Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli, and Staphylococcus aureus. Resistance rates of Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, and Serratia marcescens obtained from ICUs to carbapenems, piperacillin/tazobactam, cefoperazone/sulbactam, and amikacin were all higher than those from nonICUs（all P〈0.01）. Resistance rates of Acinetobacter baumannii, Pseudomonas aeruginosa, and Staphylococcus spp. from ICUs were all higher than those from nonICUs（P〈0.05）. Resistance rates of Acinetobacter baumannii isolated from ICUs to imipenem and meropenem were 78.0% and 79.0% respectively;while Pseudomonas aeruginosa were 25.5% and 21.6% respectively, resistance rates to other antimicrobial agents were all 〈30.0%. Isolation rate of methicillinresistant Staphylococcus aureus from ICUs was higher than that from nonICUs（39.7% vs 26.0%, P〈0.05）.ConclusionAntimicrobial resistance of bacteria isolated from ICUs is serious, rational use of antimicrobial agents should be guided according to the results of antimicrobial susceptibility testing result, so as to prevent the spread of drugresistant bacteria.