2011年至2017年某医院ICU患者感染菌谱及耐药性分析

Analysis on the infection spectrum and drug resistance characteristics of patients in intensive care unit of a hospital

目的调查医院ICU患者感染菌谱及耐药现状,为临床合理应用抗菌药物进行抗感染治疗提供依据。方法选取2011年1月至2017年12月兰州市第二人民医院ICU感染患者,送检标本按照《全国临床检验操作规程》进行分离培养及药物敏感性检测,采用WHONET5.6进行细菌分布及耐药性分析。结果7年内ICU患者送检的各类标本中共分离出细菌812株,分离率前4位为鲍曼不动杆菌(245/812,30.2%)、肺炎克雷伯菌(96/812,11.8%)、大肠埃希菌(94/812,11.6%)以及金黄色葡萄球菌(74/812,9.1%)。鲍曼不动杆菌中泛耐药株分离率为82.8%;肺炎克雷伯菌和大肠埃希菌中产生超广谱β-内酰胺酶(ESBLs)的菌株分离率分别为55.2%和80.9%,对哌拉西林/他唑巴坦耐药率较低;金黄色葡萄球菌中甲氧西林耐药金黄色葡萄球菌(MRSA)的比例为75.7%,对万古霉素、替考拉宁、利奈唑胺未发现耐药株。结论ICU感染患者感染菌谱以革兰氏阴性杆菌为主,进行经验性抗感染治疗时应重点考虑;一旦获得药敏结果,及时选用敏感药物,对提高治疗效果有重要意义。

Objective To investigate the infection spectrum and drug resistance characteristics of patients in intensive care unit(ICU)in a hospital,and to provide the scientific reference for reasonable use of antibiotics.Methods The ICU infection patients in the Second People’s Hospital of Lanzhou from January 2011 to December 2017 were selected.The samples submitted for examination were isolated and cultured in accordance with National Practice for Clinical Laboratory and tested for drug resistance analysis.Then the analysis of pathogens distribution and drug resistance characteristics were performed by WHONET5.6.Results A total of 812 strains were seprated from the samples from patients in ICU within 7 years.The top four bacteria that cause infection were Acinetobacter baumannii(245/812,30.2%),Klebsiella pneumoniae(96/812,11.8%),Escherichia coli(94/812,11.6%),and Staphylococcus aureus(74/812,9.1%).The isolation rate of pan-drug resistant bacteria in Acinetobacter baumannii was 82.8%.The isolation rates of Klebsiella pneumoniae and extended-spectrumβ-lactamases producing Escherichia coli were 55.2%and 80.9%,respectively.And their resistance rates to piperacillin/tazobactam were lower.The ratio of MRSA to Staphylococcus aureus was 75.7%,and no strains were resistant to vancomycin,teicoplanin and linezolid.Conclusions The pathogenic bacteria of infectious patients in ICU mainly were Gram-negative bacteria,which should be considered in the treatment of anti-infection.Once the result of drug resistance was obtained,the selecting sensitive drugs in time was of great significance to improve the therapeutic effect.