神经外科重症监护病房肺部感染患者细菌耐药性调查

E pidemiology and antibiotic resistance of pulmonary infections in Neurosurgical Intensive Care Unit Survey

目的对神经外科重症监护病房(NSICU)肺部感染患者细菌种类及耐药性进行调查,为预防及控制工作提供参考。方法收集厦门大学附属第一医院NSICU自2014年6月至2017年8月189例确诊肺部感染患者的临床资料,采用VITEK2全自动微生物鉴定及药敏分析系统进行病原菌鉴定及药敏分析,使用WHONET5软件进行数据统计分析。结果 NSICU肺部感染患者分离检出病原菌217株,其中革兰阳性菌44株,革兰阴性菌173株。排前4位的分别是铜绿假单胞菌48株(22.12%)、肺炎克雷伯杆菌46株(21.20%)、金黄色葡萄球菌38株(17.51%)、鲍曼不动杆菌36株(16.59%)。金黄色葡萄球菌除对万古霉素、利奈唑胺、替加环素、呋喃妥因及奎奴普丁/达福普丁等抗生素敏感(100%),以及对复方新诺明较为敏感(94.7%)之外,对其余常用抗菌药物敏感率均<65.0%;铜绿假单胞菌除阿米卡星(95.8%)、妥布霉素(89.6%)、庆大霉素(83.3%)、头孢吡肟(77.1%)以及头孢他啶(75.0%)之外,对其余抗菌药物的敏感率均<65.0%;肺炎克雷伯杆菌对阿米卡星(91.3%)、美洛培南(91.3%)、哌拉西林/舒巴坦(91.3%)、亚胺培南(89.1%)及头孢替坦(89.1%)的敏感性较高。除氨苄西林(0.0%)、哌拉西林(2.2%)及呋喃妥因(21.7%)之外,肺炎克雷伯杆菌对其余抗菌药物的敏感率均>60.0%;鲍曼不动杆菌除对妥布霉素的敏感率为33.3%之外,对其余抗菌药物的敏感率均<30.0%。结论 NSICU肺部感染病原菌呈高度集中及多重耐药趋势。应针对NSICU肺部感染及耐药菌谱特点,采取相应预防措施,控制和减少肺部感染的产生及发展。

Objective To investigate the species of pathogens causing pulmonary infections in Neurosurgical Intensive Care Unit(NSICU)and their antibiotic resistance,and offer reference for the prevention and control of pulmonary infections in NSICU.Methods The species and resistance pattern of bacterial isolates in NSICU of The First Affiliated Hospital of Xiamen University from June2014to August2017were collected and analyzed retrospectively.Bacterial identification and antibiotic susceptibility tests were carried out by using VITEK2automatic system,the data was analyzed by WHONET5software.Results Totally217strains of pathogens causing pulmonary infections were isolated,including44strains of Gram-positive cocci,173strains of Gram-negative bacilli.The top4isolated pathogens were Pseudomonas aeruginosa(P.aeruginosa)(22.12%),Klebsiella pneumonia(K.pneumonia)(21.20%),Staphylococcus aureus(S.aureus)(17.51%)and Acinetobacter baumannii(A.baumannii)(16.59%).The susceptible rates of S.aureus to all the antibiotics were less than65.0%except Vancomycin(100.0%),Linezolid(100.0%),Tigecycline(100.0%),Nitrofurantoin(100.0%),Quinupristin/Dalfopristin(100.0%)and Sulfamethoxazole(94.7%).The susceptible rates of P.aeruginosa to all the antibiotics were less than65.0%except Amikacin(95.8%),Tobramycin(89.6%),Gentamycin(83.3%),Cefepime(77.1%)and Ceftazidime(75.0%).The susceptible rates of K.pneumonia were high in Amikacin(91.3%),Meropenem(91.3%),Pipercillin/sulbactam(91.3%),imipenem(89.1%)and Cefotetan(89.1%).while to other common antibiotics,the susceptible rates were more than60.0%except Ampicillin(0.0%),Piperacillin(2.2%)and Nitrofurantoin(21.7%).The susceptible rates of A.baumannii to all the antibiotics were less than30.0%except Tobramycin(33.3%).Conclusion The pathogens causing pulmonary infections in NSICU present a trend as highly centralize and multidrug-resistant.To emphasize on the recognition of the pulmonary infections and the antibiotic resistance of NSICU,it is important to take certain preventive measures so as to control and reduce pulmonary infections.