肾脏重症监护病房病原菌分布及耐药性分析

Distribution and drug resistance of pathogenic bacteria cultured in renal intensive care unit

目的:分析肾脏重症监护病房(RICU)分离的病原菌分布及耐药性,为重症肾脏病感染的治疗提供理论依据.方法:回顾性分析2015-01-01至2019-12-31RICU送检的各种组织、体液标本中分离的病原菌分布情况及药敏结果.结果:本研究311例患者培养出559株病原菌,其中革兰阴性菌353株(63.15%),革兰阳性菌134株(23.97%)及真菌72株(12.88%).血标本培养出76株病原菌,其中革兰阴性菌45株(59.21%),革兰阳性菌27株(35.53%),真菌4株(5.26%).血培养常见的病原菌为:肺炎克雷伯菌(18.42%)、大肠埃希菌(15.79%)、金黄色葡萄球菌(14.47%)、鲍曼不动杆菌(10.53%).其中肺炎克雷伯菌和鲍曼不动杆菌碳青霉烯类药物耐药率达70%以上,耐甲氧西林金黄色葡萄球菌(MRSA)占45.45%.痰培养检出244株病原菌,其中革兰阴性菌188株(77.05%),革兰阳性菌18株(7.38%),真菌38株(15.57%).常见的病原菌包括鲍曼不动杆菌(20.90%)、肺炎克雷伯菌(15.98%)、铜绿假单胞菌(13.93%)、嗜麦芽窄食单胞菌(10.66%).其中鲍曼不动杆菌对碳青霉烯类药物耐药率达83%以上,肺炎克雷伯菌61%以上,铜绿假单胞菌碳青霉烯类药物耐药率为50%左右.结论:RICU感染患者培养的病原菌以革兰阴性菌为主,且耐药菌的检出率高.

Objective:To analyze the characteristics and drug resistance of pathogenic bacteria cultured in renal intensive care unit(RICU)to provide guidance for treatment of infection in severe patients with kidney disease.Methodology:The distribution of pathogenic bacteria and the results of drug sensitivity test in RICU from January 1,2015 to December 31,2019 were retrospectively analyzed.Results:559 strains of pathogenic bacteria were cultured in 311 patients,There are 353 gram-negative bacteria(63.15%),134 gram-positive bacteria(23.97%)and 72 fungi(12.88%).A total of 76 pathogens were detected in blood culture,including 45 gramnegative bacteria(59.21%),27 gram-positive strains(35.53%),4 fungi strains(5.26%).The common pathogens in blood culture were Klebsiella pneumoniae(18.42%),Escherichia coli(15.79%),Staphylococcus aureus(14.47%)and Acinetobacter baumannii(10.53%).Klebsiella pneumoniae and Acinetobacter baumannii resisted to carbapenems up to 70%and 45.45%of Staphylococcus aureus are MRSA.A total of 244 pathogens were detected in sputum culture,including 188 gramnegative bacteria(77.05%),18 gram-positive strains(7.38%),38 fungi strains(15.57%).The common pathogens were Acinetobacter baumannii(20.90%),Klebsiella pneumoniae(15.98%),Pseudomonas aeruginosa(13.93%),and S.maltophilia(10.66%).The drug resistance rate of Acinetobacter baumannii to carbapenem was more than 83%,Klebsiella pneumoniae was more than 61%,and the drug resistance rate of Pseudomonas aeruginosa carbapenem was about 50%.Conclusion:Gram-negative bacteria were the main pathogens in RICU patients,and the detection rate of drug-resistant bacteria was high.