深圳某三甲医院2019年ICU病原菌分布及耐药性分析

Distribution and drug resistance of pathogens in ICU of a major hospital in Shenzhen in 2019

目的分析2019年深圳市人民医院ICU检出病原菌分布情况,并分析其耐药性,为ICU治疗重症感染患者提供依据。方法选择深圳市人民医院2019年1-12月ICU检出病原菌524株,采用WHONET5.6软件进行数据分析。结果ICU患者感染的主要病原菌为革兰阴性菌,共263株(50.2%),占前5位的分别为鲍曼不动杆菌(11.6%),铜绿假单胞菌(9.4%),嗜麦芽寡养单胞菌(6.5%),大肠埃希菌(7.8%)和肺炎克雷伯菌(6.1%),且主要分布在呼吸道标本中;分离出革兰阳性菌157株(30.0%),真菌104株(19.8%)。我院ICU鲍曼不动杆菌呈高度耐药性,对碳青霉烯类耐药率>90%,铜绿假单胞菌近年检出率及耐药率均呈上升趋势,肠杆菌科细菌中耐碳青酶烯肺炎克雷伯菌(CR-KP)达25.0%。结论我院2019年ICU的不同标本病原菌分布不同,以革兰阴性菌为主,治疗多重耐药菌(MDR)主要应用药物为替加环素和多黏菌素。应加强病原菌监测及耐药分析,及时关注新型抗菌药物(加酶抑制剂、新型头孢菌素)研发和更新,为临床提供精准指导。

Objective To analyze the distribution and drug resistance rate of pathogens detected in the intensive care unit(ICU)of Shenzhen People's Hospital in 2019,which provides guidance for treatment of patients with severe infection.Method A total of 524 pathogens were isolated in the ICU of Shenzhen People's Hospital from January to December 2019.The WHONET5.6 was used for data analysis.Result The pathogens were mainly Gram-negative bacteria,with a total of 263 strains(50.0%).The top five pathogens were Acinetobacter baumannii(11.6%),Pseudomonas aeruginosa(9.4%),Stenotrophomonas maltophilia(6.5%),Escherichia coli(7.8%)and Klebsiella pneumoniae(6.1%),which mainly distributed in respiratory specimens;157 strains of Gram-positive bacteria(30.0%)and fungi 104 strains(19.8%)were also isolated.Acinetobacter baumannii showed high drug resistance in the ICU of this hospital,and its drug resistance rate to carbapenems was>90%.The detection rate and drug resistance rate of Pseudomonas aeruginosa showed an increasing trend in recent years,and carbapenem-resistant Klebsiella pneumoniae(CR-KP)in Enterobacteriaceae bacteria was up to 25.0%.Conclusion The distribution of pathogens in different specimens of the ICU was different in our hospital in 2019.Gram-negative bacteria were the main pathogenic bacteria.Tigecycline and polymyxin were the main drugs used for treating multidrug-resistant Gram-negative bacteria(MDR)infection.Therefore,we should strengthen the monitoring of the change of pathogenic bacteria,analyze their drug resistance,and pay more timely attention to the development and update of new antibacterial drugs in order to give accurate and precise guidance to clinical decision-making.