2013-2017年ICU血培养病原菌分布及耐药趋势分析

Distribution and drug resistance of blood culture pathogens in ICU from 2013 to 2017

目的分析2013-2017年重症监护病房(ICU)血培养阳性病原菌分布及耐药特点,为临床抗感染治疗提供依据。方法收集2013-2017年ICU血培养阳性菌株1249株;细菌鉴定采用法国生物梅里埃公司ATB Expression微生物分析仪;细菌药物敏感性测定采用纸片扩散法;采用WHONET5.6软件对药敏结果进行统计分析,数据处理使用SPSS17.0进行分析。结果革兰阳性菌占59.57%,主要为凝固酶阴性葡萄球菌;革兰阴性菌占35.39%,主要为肺炎克雷伯菌;金黄色葡萄球菌、表皮葡萄球菌对青霉素G、红霉素、磺胺甲噁唑/甲氧苄啶、莫西沙星耐药率呈上升趋势;对万古霉素、利奈唑烷、替加环素耐药率均为0;表皮葡萄球菌对左氧氟沙星、利福平呈下降趋势(P<0.05);肺炎克雷伯菌对头孢唑林、哌拉西林/他唑巴坦、头孢吡肟及亚胺培南耐药率有统计学差异(P<0.05),对替加环素耐药率较低;鲍氏不动杆菌对氨苄西林/舒巴坦、头孢唑林、呋喃妥因耐药率均达100.00%,对庆大霉素、磺胺甲噁唑/甲氧苄啶、妥布霉素耐药率呈下降趋势(P<0.05),对替加环素耐药率为0;多药耐药菌的总检出率为26.32%,其中CRAB检出率为80.77%,MRSA检出率为56.32%。结论 ICU血流感染病原菌种类复杂,多药耐药菌检出率呈逐年上升趋势,医院感染防控形势严峻,需要加强多部门协作,严格采取有效措施减少耐药株在院内传播。

OBJF-J2TIVE To investigate the distribution and drug resistance of blood culture-positive pathogens in in- tensive care unit during 2013-2017 so as to provide guidance for clinical treatment of infections. METHODS A total of 1249 strains of blood culture-positive pathogens were collected. The pathogens were identified by using ATB Expression microbial analyzer of BioM6rieux, France, the drug susceptibility testing was carried out with the use of disk diffusion method, the result of the drug susceptibility testing was statistically analyzed by means of WHO- NETS.6 software, and the statistical analysis was performed with the use of SPSS17.0 software.RESULTS The gram-positive bacteria accounted for 59.57%, among which coagulase-negative Staphylococcus was dominant. The gram-negative bacteria accounted for 35.39 ~, among which Klebsiella pneurnoniae was dominant. The drug re- sistance rates of Staphylococcus aureus and Staphylococcus epiderrnidis to penicillin G, erythromycin, sulfame- thoxazole-trimethoprim and moxifloxaein showed upward trends, the drug resistance rates to vancomycin, linezol- id and tigecycline were 0~ the drug resistance rates of S.epiderrnidis strains to levofloxacin and rifampicin showed downward trends （P^0.05） ~ there were significant differences in the drug resistance rates to cefazolin, piperacil- lin-tazobactam, cefepime and imipenem among the K.pneurnoniae strains （P〈0.05）, the drug resistance rate to tigecyeline was low; the drug resistance rates of Acinetobacter baurnannii strains to ampicillin-sulbactam, cefazo- lin and nitrofurantoin were 100.00%, the drug resistance rates to gentamicin, sulfamethoxazole-trimethoprim and tobramycin showed downward trends （P^0.05）, and the drug resistance rate to tigecycline was 0. The total isola- tion rate of multidrug-resistance organisms （MDROs） was 26.32%, the isolation rate of CRAB 80.77~, the iso- lation rate of MRSA 56.32 %.CONCLUSION There are a variety of species of pathogens causing bloodstream infec- tion in ICU, the isolation rate of MDROs is increased year by year, the prevention and control of nosoeomial infec- tion is severe, and it to prevent the spread is necessary to strengthen the multidisciplinary collaboration and take effective measures so as of drug-resistant strains in hospitals.