重症监护病房耐药菌的监测与用药分析

Surveillance and Drug Analysis of Pathogenic Bacteria in Intensive Care Unit

目的:了解本院重症监护室(ICU)常见病原菌的分布及耐药情况,为指导医院感染病原菌耐药性监测和临床合理使用抗生素提供依据。方法:使用全自动微生物分析系统(VITEK2 COMPACT)对ICU患者的标本进行细菌鉴定和药敏试验,并运用WHONET5.6软件对微生物检测结果进行统计分析,结果判定依据NCCLS颁布的标准。结果:在2015份送检标本中,检出病原菌656株,阳性检出率为32.57%。其中革兰氏阴性杆菌占83.4%,革兰氏阳性球菌占16.6%。革兰氏阴性杆菌中主要以鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌和大肠埃希菌为主,均对头孢类抗菌药物耐药率较高,尤其以鲍氏不动杆菌的耐药率最高,对亚胺培南、哌拉西林/他唑巴坦耐药率较低;革兰氏阳性球菌以金黄色葡萄球菌为主,对青霉素和头孢耐药较高,暂未发现对万古霉素耐药的葡萄球菌。结论:重症监护病房以多重耐药的革兰氏阴性杆菌为主。临床上应加强ICU细菌耐药监测,合理使用抗生素,并采取综合干预措施可有效降低多重耐药菌的感染发病率。

Objective： To analyze the distributions and drug resistance status of common pathogenic bacteria in intensive care units, in order to provide the information for reasonable use of antibacterial agents and guide the drug resistance monitoring. Methods： The pathogenic bacterial identification and drug sensitive test of bacteria were carried out using an automatic microbial analysis system （ VITEK2 COMPACT）, WHONETS. 6 software was used for statistical analysis, The results are based on NCCLS standards. Results： In the 2015 inspection specimens, 656pathogenswere detected, the bacterial isolating rate was 32. 57%. Among the isolated bacterial, gram negative bacilli accounted for83.4%, gram positive cocci accounted for 16. 6%. Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli were the main gram - negative bacilli. They were higher resistance rate to cephalosporins antibiotics, especially in the highest resistance rate of Acinetobacter baumannii, Resistance rate to imipenem, piperacillin/tazobactam is lower. Staphylococcus aureus were the main gram - positive cocci. The resistance rate to penicillin and cephalosporins was higher, no vancomycin - resistant staphylococci were found. Conclusion： Gram negative bacteria is the main bacteria in ICU. Clinically, it should strengthen the monitoring, give reasonable antibiotic treatment and take comprehensive interventions, which can effectively reduce the incidence of multi- drug- resistant infections.