ICU与非ICU病房致病革兰阴性杆菌及其耐药性差异分析

Difference and analysis of Gram-negative bacilli and its drug resistance between ICU and non-ICU wards

目的探讨本院ICU与非ICU病房分离的致病革兰阴性杆菌分布及其对临床常用抗生素的耐药性差异,为临床治疗提供依据。方法回顾本院2016年1月-2017年12月住院患者的临床和微生物学资料,对比分析ICU与非ICU病房感染患者的致病菌分布特点及耐药性情况。结果共分离阴性致病菌2 874株,其中ICU分离685株,占比23. 8%;非ICU分离2 189株,占比76. 2%;ICU分离株的耐药率普遍高于非ICU病房,其中大肠埃希菌对头孢曲松耐药率差异有统计学意义(P <0. 01);肺炎克雷伯菌对亚胺培南耐药率差异有统计学意义(P <0. 01);鲍曼不动杆菌对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、头孢曲松、头孢吡肟、左氧氟沙星和亚胺培南的耐药率差异有统计学意义(P <0. 01);铜绿假单胞菌在ICU和非ICU病房的耐药率差异无统计学意义(P> 0. 05)。结论与非ICU相比,ICU病房耐药率更高,不同病区之间应区别给药,并加强细菌耐药监测,为诊断前的经验用药提供依据。

Objective To investigate the distribution and the differences in antibiotic resistance of the pathogenic gram-negative bacteria between ICU and non ICU wards,so as to provide basis for antibiotic therapy. Methods Retrospective analysis was conducted to the clinical and microbiological data of inpatients from 2016 January to 2017 December. Comparative analysis was performed on the distribution and antibiotic resistance of the pathogenic bacteria between ICU and non ICU wards.Results A total of 2 874 pathogenic gram-negative bacteria were isolated. 685 strains( 23. 8%) were isolated from ICU ward and 2 189 strains( 76. 2%) were isolated from non ICU wards. Antibiotic resistant rate of strains from ICU ward was generally higher than that from non ICU wards. The difference in antibiotic resistance rate of E. coli strains to ceftriaxone between the two wards was statistically significant( P < 0. 01);Antibiotic resistance rate of K. pneumonia strains to imipenem between the two wards was statistically significant( P < 0. 01);Antibiotic resistance rate of A. baumannii strains to cefoperazone/sulbactam,piperacillin/tazobactam,ceftriaxone,cefepime,levofloxacin and imipenem between the two wards were statistically significant( P < 0. 01). There was no statistical significance on the differences in resistance rate of P. aeruginosa strains between ICU and non ICU wards( P > 0. 05). Conclusion Compared with non-ICU,the resistance rate in ICU wards is higher. Different wards should be administered differently,and bacterial resistance monitoring should be strengthened to provide basis for empirical drug use before diagnosis.