二级综合医院ICU患者感染病原菌构成及耐药监测分析

Analysis of Pathogenic Bacteria Composition and Drug Resistance of ICU Patients in Two Grade General Hospital

目的探讨二级综合医院ICU住院患者感染病原菌的分布特点及耐药性,为临床合理使用抗菌药物提供参考。方法对2014年1月—2016年12月某二级综合医院ICU住院患者送检的临床标本中分离病原菌的构成及耐药性进行回顾性分析。结果共分离出病原菌365株,其中革兰阴性菌占60.5%,革兰阳性菌占23.6%,真菌占15.9%。感染病原菌以肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、金黄色葡萄球菌、白色假丝酵母菌及屎肠球菌为主,分别占17.8%、12.1%、11.2%、11.0%、7.7%、6.6%及5.8%。病原菌对抗菌药物耐药严重,肺炎克伯菌、大肠埃希菌对亚胺培南、阿米卡星、哌拉西林/三唑巴坦及阿莫西林/克拉维酸的耐药率较低;鲍曼不动杆菌及铜绿假单胞菌除头孢他啶和多黏菌素外,亚胺培南、美罗培南、阿米卡星、头孢吡肟耐药率在50.0%左右,其他抗菌药物的耐药率>60.0%;金黄色葡萄球菌和屎肠球菌对万古霉素、利奈唑胺、替考拉宁耐药率为0.0%,对青霉素、环丙沙星、左氧氟沙星、四环素、红霉素及克林霉素的耐药率在80.0%以上,金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌(MRSA)感染占82.1%,屎肠球菌对高浓度庆大霉素耐药率为71.2%,对高浓度链霉素耐药率为57.1%。真菌对两性霉素B、5-氟胞嘧啶、伏立康唑均出现少量耐药株,对氟康唑、伊曲康唑出现不同程度的耐药。结论二级综合医院ICU患者感染病原菌主要为革兰阴性菌,且以多重耐药菌株感染多见,病原菌对常用抗菌药物耐药严重,临床应根据药敏结果合理应用抗菌药物。

Objective To investigate the distribution characteristics and drug resistance of pathogens isolated from ICU inpatients in grade two general hospitals, and to provide reference for rational use of antibiotics in clinic. Methods The composition and drug resistance of pathogenic bacteria isolated from clinical specimens of ICU inpatients in a general hospital of grade two from January 2014 to December 2016 were retrospectively analyzed. Results A total of 365 strains of pathogenic bacteria were isolated, among which gram negative bacilli accounted for 60.54%, gram positive cocci for 23.6%, and fungi accounted for 15.9%. Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter Bauman, Staphylococcus aureus, Candida albicans and Enterococcus faecium are main pathogens, accounted for 17.8%, 12.1%, 11.2%, 11.0%, 7.7%, 6.6% and 5.8%. Pathogenic bacteria is seriously resistant to antibacterial drugs. The resistance rate of klebsiella pneumoniae and Escherichia coli to imipenem, amikacin, piperacillin/tazobactam and amoxicillin/clavulanic acid is lower. In addition to ceftazidime and polymyxin, the resistance rate of bauman acinetobacter and pseudomonas aeruginosa to imipenem, meropenem, amikacin, cefepime is about 50%, and to other antibacterial drugs is higher than 60%. The resistance rate of staphylococcus aureus and enteroeoccus faecium to vancomycin, linezolid and teieoplanin is zero, and to penicillin, ciprofloxacin, levofloxacin, tetracycline, erythromycin and elindamycin is above 80%. MRSA accounted for 82.1% of infected Staphylococcus aureus. The resistance rate of enterococcus faecium to high concentration gentamicin is 71.2%, and to high concentration streptomycin is 57.1%. Fungi showed a small number of resistant strains of Amphotericin B, Cytosine, and Voriconazole. Fungi showed varying degrees of resistance to fluconazole and itraconazole. Conclusion The pathogens of infection in ICU patients in grade two general hospital are mainly gram negative bacilli, and the infection is more common in multidrug-resistant isolates. Pathogens are seriously resistant to common antibiotics, and clinicians should rationally select antimicrobial agents according to the results of susceptibility testing.