重症监护病房多重耐药菌检出及药物敏感性

Comparison of multi-drug resistant bacteria and drug sensitivity in intensive care unit

目的探究比较重症监护病房(ICU)与非重症监护病房多重耐药菌(Multiple drug-resistant bacteria,MDRO)检出及药物敏感性。方法收集2016年1月-2018年12月青岛市市立医院住院患者的血液、痰液、尿液、伤口分泌物等不同的临床标本,对其病原菌分离培养后,进行细菌鉴定和药敏试验。结果 493例临床标本共检出病原菌584株,其中MDRO 115株,检出率19.69%。183例ICU患者检出病原菌217株,MDRO检出率36.41%,310例非ICU检出367株,MDRO检出率9.81%。ICU的MDRO检出率高于非ICU(P<0.05)。病原菌以大肠埃希菌、铜绿假单胞菌及鲍氏不动杆菌为主,分别为42.29%、36.47%、11.64%。ICU鲍氏不动杆菌MDRO检出率为69.44%、非ICU鲍氏不动杆菌MDRO检出率为31.25%,大肠埃希菌、铜绿假单胞杆菌、鲍氏不动杆菌MDRO检出率具有统计学差异(P<0.05)。ICU检出的铜绿假单胞菌、鲍氏不动杆菌耐药性总体高于非ICU(P<0.05)。结论重症监护病房的MDRO检出率及耐药性高于非重症监护病房,为临床抗菌药物使用及抗感染治疗提供依据,医院应加强重症监护病房的常见MDRO检测,合理使用抗菌药物,降低MDRO感染率。

OBJECTIVE To explore the detection and drug sensitivity of multi-drug resistant bacteria in intensive care unit and non-intensive care unit. METHODS Different clinical specimens such as blood, sputum, urine, and wound secretions were collected from hospitalized patients in the Municipal Hospital of Qingdao from January to February 2018. Pathogens isolated from the specimens were identified and tested for drug susceptibility. RESULTS A total of 584 pathogens were detected in 493 clinical specimens, of which 115 were multi-drug resistant, with a total detection rate of 19.69%. Pathogens detected in 183 ICU patients were 217 strains, the total multi-resistance detection rate was 36.41%. And 367 strains were detected in 310 non-ICU patients, with the total multi-resistance detection rate of 9.81%. The detection rate of multi-drug resistant bacteria in ICU patients was significantly higher than that in non-ICU patients(P<0.05). The top three detection rates of pathogens were Escherichia coli, Pseudomonas aeruginosa and Acinetobacter baumannii, which were 42.29%, 36.47% and 11.64%, respectively. The multi-drug resistant bacterial rate of A. baumannii in ICU patients was 69.44%, whereas that in non-ICU patients was 31.25%. The detection rate of multi-drug resistance of P. aeruginosa and A. baumannii between ICU patients and non-ICU patients was significant(P<0.05). The resistant rate of P. aeruginosa and A. baumannii detected in ICU patients was significantly higher than that in non-ICU patients(P<0.05). CONCLUSION The detection rate and multi-drug resistant rate of bacteria in intensive care units was higher than that in non-intensive care units, which provided evidence for clinical antibiotic usage and anti-infectious treatment. Hospitals should strengthen the detection of common multi-drug resistant bacteria in intensive care units, and rational use of antibacterial agents to reduce the incidence of multi-drug resistant infections.