神经重症监护病房的病原菌分布及耐药性分析

Distribution and drug resistance of pathogens in neuro-intensive care unit

目的分析神经重症监护病房(NCU)病原菌分布及耐药情况,为危重症患者临床抗感染治疗提供依据。方法回顾性分析2015年6月~2017年6月某医院NCU住院治疗患者的315份各类临床标本,采用纸片扩散法(Kirby-Bauer法),同时部分细菌使用VITER系统配套的药敏卡进行药敏试验;药敏结果根据临床和实验室标准协会(CLSI)2015年版标准进行判定。结果 315份临床标本中共分离出阳性病原菌186株,病原菌分布以革兰阴性菌为主,共156株,占总菌株83.87%,革兰阳性菌20株,占10.75%,真菌13株,占6.99%;革兰阴性菌主要为肺炎克雷伯菌,其次是铜绿假单胞菌、鲍曼不动杆菌;革兰阳性菌主要为耐甲氧西林金黄色葡萄球菌(MRSA),其次为耐甲氧西林凝固酶阴性葡萄球菌(MRCNS);真菌以白色假丝酵母菌为主;药敏结果显示鲍曼不动杆菌和肺炎克雷伯菌对碳青霉烯类及四环素类抗生素表现为较低的耐药率;铜绿假单胞菌对复合型及多肽类抗菌药物有较低的耐药率;MRSA和MRCNS对替加环素、万古霉素、利奈唑胺、替考拉宁的耐药率较低;白色念珠菌对两性霉素B有较低耐药率。结论 NCU病原菌分布主要以革兰阴性菌为主,且对各种抗菌药物的耐药性差异较大,应进一步加强监测,临床上应根据药敏结果及抗生素使用原则选择合适的抗生素,以减少耐药菌感染的发生。

Objective To investigate the distribution and drug resistance of pathogens in neuro-intensive care unit （NCU）, and provide evidence for clinical anti-infective treatment of critical patients. Methods Retrospective analysis was conducted using 315 clinical samples of patients in NCU collected from Jun 2015 to Jun 2017. Susceptibility test was performed by the disk diffusion method（K-B method） and the VITER system supporting drug susceptibility cards were also used for some strains. Susceptibility results were determined according to the 2015 edition of Clinical and Laboratory Standards Institute （CLSI）. Results 186 positive strains of pathogens were isolated from 315 samples, includ- ing 156（83.87%） strains of Gram-negative bacteria, 20（10.75%） strains of Gram-positive bacteria and 13（6.99%） strains of fungus. Gram-negative bacteria were mainly Klebsiella pneumoniae, followed by Pseudomonas aeruginosa and Acinetobacter baumannii;Gram-positive bacteria were mainly methieillin-resistant Staphylococcus aureus （MRSA）, fol lowed by methicillin-resistant coagulase-negative Staphylocoeeus（MRCNS）; fungi were mainly Candida albicans. Susceptibility test reported that Bowman Acinetobacter and Klebsiella pneumonia showed lower rate of resistance to carbapeneros and tetracycline antibiotics; Pseudomonas aeruginosa had lower rate of resistance to complex and peptide antibiotics; MRSA and MRCNS showed lower resistance rate to tigecycline, vancomycin, linezolid and teicoplanin; Candida albicans presented lower resistance rate on amphotericin B. Conclusion Pathogens in NCU were mainly Gram-negative bacteria and showed quite a difference in the resistance of various antibiotic. In order to reduce the incidence of drugresistance bacterial infection, it is necessary to promote the surveillance and choose appropriate antibiotics based on susceptibility test and drug-use principles.