新建医院ICU临床分离菌的分布及耐药变迁

Distribution and drug resistance change of clinical isolates in ICU of a new hospital

目的研究新建医院ICU自建院以来的病原菌分布情况及耐药性变化,为医院感控管理和临床感染防治工作提供依据.方法回顾性分析2014年1月至2018年12月ICU临床标本培养阳性的菌株分布和耐药情况.采用法国梅里埃公司的全自动微生物鉴定仪进行细菌鉴定,主要应用相对数和卡方检验进行统计学分析.结果1784株病原菌中,革兰阴性菌占68.27%,以鲍曼不动杆菌、铜绿假单胞菌、大肠埃希菌和肺炎克雷伯菌居多,标本主要来源为痰液(62.89%)和尿液(11.49%);革兰阳性菌占21.13%,主要包括金黄色葡萄球菌、屎肠球菌,标本主要来源为血液(30.77%)和尿液(23.08%).同种细菌中,多重耐药鲍曼不动杆菌(MDR-AB)在建院第二年的年检出率升至93.75%,泛耐药鲍曼不动杆菌(XDR-AB)在2015年4月份开始流行;产ESBLs大肠埃希菌(ESBLs-EC)、耐碳青霉烯铜绿假单胞菌(CR-PA)、耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的平均检出率分别为68.31%、53.48%、60.55%和86.87%.在2014年检出耐万古霉素的屎肠球菌1株.结论新建医院ICU需警惕和预防鲍曼不动杆菌的环境定植和感染暴发.ICU分离病原菌中非发酵革兰阴性杆菌、葡萄球菌、肠球菌的耐药形势严峻,需加强对MDR-AB、CR-PA、MRSA、MRCNS、ESBLs-EC的监测,积极预防下呼吸道、尿路感染及导管相关血流感染,根据耐药流行病学合理选用抗菌药物.

Objective To clarify the distribution and drug resistance change of clinical isolates in ICU of a new hospital,and to provide evidence for clinical infection prevention and management.Methods The distribution and drug sensitivity of positive strains were retrospectively analyzed from January 2014 to December 2018 in ICU.Bacteria identification was carried out by the full-automatic microbial identification instrument of French Merrier,and the relative numbers and chi-square test were mainly used for statistical analysis.Results 68.27%of 1784 strains were Gram-negative bacteria mainly from sputum(62.89%)and urine(11.49%),and most of them were Acinetobacter baumannii,Pseudomonas aeruginosa,Escherichia coli and Klebsiella pneumoniae.21.13%of 1784 strains were Gram-positive bacteria mainly from blood(30.77%)and urine(23.08%),and most of them were Staphylococcus aureus and Enterococcus faecalis.Among the same species of bacteria,the detection rate of multidrug-resistant Acinetobacter baumannii(MDRAB)was 93.75%in the second year.Extensively drug resistant Acinetobacter baumannii(XDR-AB)had been preva lent in April 2015.The average detection rate of ESBLs-producing Escherichia coli(ESBLs-EC),carbapenem-resistant Pseudomonas aeruginosa(CR-PA),methicillin-resistant Staphylococcus aureus(MRSA)and methicillin-resistant Coagulase-negative staphylococcus(MRCNS)were 68.31%,53.48%,60.55%and 86.87%,respectively.One strain of vancomycin-resistant Enterococcus faecalis was detected in 2014.Conclusion The new ICU should strengthen prevention of Acinetobacter baumannii colonization and epidemics.The drug resistance of isolates,especially non-fermenting Gram-negative bacilli,staphylococcus and enterococci,is significant in ICU.It is necessary to monitor drug resistance of MDR-AB,CR-PA,MRSA,MRCNS and ESBLs-EC,prevent nosocomial infection,and select rational antibiotics according to the prevalence of drug resistance.