临床感染标本的病原菌分布及耐药性分析

Distribution and drug resistance of pathogens in clinical infection samples

目的:获取我院急诊重症监护室(EICU)5年来病原菌分布和耐药状况的流行病学资料,为临床合理使用抗菌药物和经验治疗提供依据。方法:收集2016年1月—2020年12月期间从西京医院EICU送检的微生物样本中检出的病原菌,采用梅里埃全自动细菌鉴定及药敏分析系统(VITEK 2 Compact)进行病原菌的鉴定,抗生素的最低抑菌浓度采用微量肉汤稀释法测定。结果:2016年1月—2020年12月共5年时间里,西京医院EICU收治的107例患者共送检微生物样本1089份,分离出病原菌317株(按初次分离计算),其中革兰阳性菌101株(31.86%),革兰阴性菌182株(57.41%),真菌34株(10.73%)。病原菌检出率最高的是鲍曼不动杆菌(41株,12.93%),其次是金黄色葡萄球菌(37株,11.67%)和肺炎克雷伯菌(32株,10.09%);患者以呼吸道(33.64%)和泌尿系感染(22.43%)为主,检出率较高的是呼吸道(34.69%)和血液(33.12%)样本;不同年份中鲍曼不动杆菌对亚胺培南的耐药率超过70%,金黄色葡萄球菌对苯唑西林的耐药率在90%~100%,肺炎克雷伯菌对氨苄西林/舒巴坦的耐药率为37.5%~87.5%,热带念珠菌对唑类常规抗真菌的耐药率在14%~29%。结论:我院EICU革兰阴性菌的检出数量明显高于革兰阳性菌,细菌和非白念珠菌的耐药率呈逐渐上升趋势。

Objective: To obtain the epidemiological data of pathogen distribution and drug resistance in emergency intensive care unit(EICU) of our hospital in the past five years, so as to provide the basis for clinical rational use of antibiotics and empirical treatment. Methods: The pathogenic bacteria were collected from the microbial samples submitted by EICU of Xijing Hospital from January 2016 to December 2020. The pathogens were identified by merier VITEK 2 compact automatic bacterial identification and drug sensitivity analysis system, and the minimum inhibitory concentration(MIC) of antibiotics was determined by broth dilution method. Results: During the 5 years from January 2016 to December 2020, 107 patients admitted to the EICU of Xijing Hospital sent a total of 1089 microbial samples for examination, and 317 pathogenic bacteria were isolated(calculated based on the initial isolation), of which 101 were Gram-positive bacteria(31.86%), 182 strains of Gram-negative bacteria(57.41%), 34 strains of fungi(10.73%). The highest pathogen detection rate is Acinetobacter baumannii(41 strains, 12.93%), followed by Staphylococcus aureus(37 strains, 11.67%), and Klebsiella pneumoniae(32 strains, 10.09%). The main types of patients are respiratory tract(33.64%) and urinary tract infections(22.43%). The higher detection rate was found in respiratory tract(34.69%) and blood(33.12%) samples. In different years, the drug resistance rate of Acinetobacter baumannii to imipenem was more than 70%, and the drug resistance rate of Staphylococcus aureus to oxacillin was 90.0% to 100%. The drug resistance rate of Klebsiella pneumoniae to ampicillin/sulbactam was 37.5% to 87.5%. The drug resistance rate of Candida tropicalis to azole conventional antifungal was 14% to 29%. Conclusion: The number of Gram-negative bacteria detected in EICU of our hospital was significantly higher than that of Gram-positive bacteria, and the drug resistance rate of bacteria and non-Candida albicans showed a gradually increasing trend.