2014~2019年我院ICU感染病原菌分布及耐药性分析

Analysis of the Distribution and Drug Resistance of Pathogenic Bacteria in the ICU of Our Hospital from 2014 to 2019

目的分析我院ICU患者感染病原菌的分布及耐药性,为临床合理选择抗菌药物提供依据。方法回顾我院ICU 2014年1月~2019年12月送检各类型标本所分离的病原菌,分析其耐药性。结果 6年共分离出病原菌3407株,其中革兰阴性杆菌2511株(73.70%),以鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、大肠埃希氏菌为主;革兰阳性球菌896株(26.30%),以屎肠球菌、金黄色葡萄球菌、粪肠球菌、人葡萄球菌为主。鲍曼不动杆菌对所检测的抗菌药物均保持较高耐药率(72.89%~79.56%),铜绿假单胞菌对氨基糖苷类(阿米卡星,庆大霉素)抗菌药物保持较高的敏感性(8.15%~15.31%),其次为哌拉西林/他唑巴坦(24.63%)和头孢他啶(30.95%)。肺炎克雷伯菌对各种抗菌药物的耐药率整体高于大肠埃希氏菌,其中大肠埃希氏菌对亚胺培南和美罗培南耐药率分别为8.67%和10.00%,而对左旋氧氟沙星和环丙沙星耐药率分别为67.33%和66.67%;肺炎克雷伯菌除了对阿米卡星具有稍低的耐药性(38.15%),对其他各类抗菌药物的耐药率波动在40.76%~63.45%。葡萄球菌属细菌对红霉素、青霉素具有较高的耐药率,波动在73.82%~82.09%,对万古霉素和利奈唑胺耐药率为0。屎肠球菌和粪肠球菌对万古霉素和利奈唑胺具有较高的敏感性,耐药率波动在0.62%~13.85%。结论我院ICU感染病原菌主要为革兰阴性杆菌,且耐药情况严重,以鲍曼不动杆菌耐药显著。应加强对ICU病原菌的耐药性监测,指导临床合理选用抗菌药物。

Objective To analyze the distribution and drug resistance of infectious pathogens in ICU patients in our hospital,and provide a basis for clinically reasonable selection of antimicrobial drugs.Methods To review the pathogenic bacteria isolated from various types of specimens sent to the ICU in our hospital from January 2014 to December 2019,and analyze their drug resistance.Results A total of 3407 strains of pathogenic bacteria were isolated in 6 years,among which 2511 strains(73.70%)of gram-negative bacilli,mainly Acinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumoniae,and Escherichia coli;Gram 896 strains(26.30%)of positive cocci were mainly Enterococcus faecium,Staphylococcus aureus,Enterococcus faecalis,and Staphylococcus human.Acinetobacter baumannii maintained a high resistance rate(72.89%-79.56%)to the tested antibacterial drugs.Pseudomonas aeruginosa maintained relatively high resistance to aminoglycoside(amikacin,gentamicin)antibacterial drugs.High sensitivity(8.15%-15.31%),followed by piperacillin/tazobactam(24.63%)and ceftazidime(30.95%).The resistance rate of Klebsiella pneumoniae to various antibacterial drugs is higher than that of Escherichia coli.The resistance rates of Escherichia coli to imipenem and meropenem are 8.67%and 10.00%,respectively.The resistance rates of ofloxacin and ciprofloxacin are 67.33%and 66.67%,respectively;Klebsiella pneumoniae has a slightly lower resistance to amikacin(38.15%),and is resistant to other types of antibacterial drugs.The resistance rate fluctuated from 40.76%to 63.45%.Staphylococcus bacteria have a high resistance rate to erythromycin and penicillin,fluctuating from 73.82%to 82.09%,and the resistance rate to vancomycin and linezolid is 0.Enterococcus faecium and Enterococcus faecalis are highly sensitive to vancomycin and linezolid,and the resistance rate fluctuates from 0.62%to 13.85%.Conclusion The pathogens of the ICU infection in our hospital are mainly Gram-negative bacilli,and the drug resistance is serious,Acinetobacter baumannii has significant drug resistance.The drug resistance monitoring of pathogens in ICU should be strengthened to guide the rational selection of antibacterial drugs in clinic.