2015—2017年德阳市人民医院重症监护室感染病原菌分布及耐药性分析

Analysis on distribution and drug resistance of pathogens of hospital infection in intensive care unit of People's Hospital of Deyang City from 2015 to 2017

目的分析2015—2017年德阳市人民医院重症监护室感染病原菌分布及耐药性,为临床使用抗菌药物提供依据。方法选取2015年1月—2017年12月临床送检的重症监护室标本中鉴定出的感染病原菌进行菌种鉴定,并对病原菌分布及耐药性进行分析。结果共分离出4 890株病原菌,标本主要来源于痰液(39.51%),其中革兰阴性菌3 902株,占79.80%,主要为大肠埃希菌和肺炎克雷伯菌;革兰阳性菌998株,占20.20%,主要为金黄色葡萄球菌和溶血葡萄球菌。金黄色葡萄球菌和溶血葡萄球菌对常用抗菌药物都有一定程度的耐药,对复方新诺明、喹奴普丁/达福普汀的耐药率在10%以下,对万古霉素和利奈唑胺完全敏感,没有耐药性。大肠埃希菌和肺炎克雷伯菌对大部分抗菌药物的耐药率在50%～80%,二者对哌拉西林、头孢西丁、亚胺培南、阿莫西林克拉维酸、哌拉西林/他唑巴坦、替卡西林/棒酸的耐药率较低,均在10%以下。结论德阳市人民医院重症监护室感染病原菌分布广泛,针对感染性疾病进行用药时,要在使用抗菌药物之前留取相应的标本,且尽量减少或避免长期滥用抗菌药物,避免根据经验用药,以减免耐药性的产生。

Objective To analyze the distribution and drug resistance of pathogenic bacteria of hospital infection in Intensive Care Unit of People’s Hospital of Deyang City from 2015 to 2017, and in order to further provide the reference for rational use of antibacterial agents. Methods Bacterial pathogens submitted to the hospital from January 2015 to December 2017 in the intensive care unit clinically were selected to identify strains. And the distribution and drug resistance of pathogenic bacteria were analyzed. Results A total of 4 890 bacterial strains were isolated, and most of them were isolated from sputum(39.51%). Gram-negative(3 902 strains) accounted for 79.80%, and main of them were Escherichia coli and Klebsiella pneumoniae. Gram-positive bacteria bacteria were 998 strains(20.20%), and main of them were Staphylococcus aureus and Staphylococcus haemolyticus. S. aureus and S. haemolyticus had some resistant to common antibacterial agents, while the resistant rate of S. aureus and S. haemolyticus against trimethoprim/sulfamethoxazole and quinupristin and dalfotristin were below 10%. They were completely sensitive to vancomycin and linezolid with no resistance. The resistant rate of E. coli and K. pneumoniae against most antibacterial agents were 50%- 80%. The resistant rates of E. coli and K. pneumoniae against piperacillin, cefoxitin, imipenem, amoxicillin and clavulanate, ticarcillin/clavulanic acid were lower, and they were below 10%. Conclusion Pathogens of hospital infection in intensive care unit are widely distributed in People’s Hospital of Deyang City. When taking drugs against infectious diseases, doctors should keep the corresponding specimens before using antibiotics, and try to reduce or avoid long-term abuse of antibiotics, avoid medication according to experience, in order to reduce the occurrence of drug resistance.