重症监护病房8年间腹水培养阳性患者病原菌的检测与耐药性分析

The profile of antibiotic resistant pathogens isolated from ascites fluid patients in intensive care unit during past 8 years

目的分析重症监护病房(ICU)腹腔感染患者腹水培养中病原菌的构成及耐药情况,为临床医生合理使用抗感染药物提供参考。方法对2012年1月至2019年12月间临床送检的腹水标本进行病原菌的分离和药敏试验,收集相关资料,并对阳性标本病原菌在临床上的分布特点及其耐药情况进一步分析总结。结果共检出阳性标本256例(剔除同一病人的重复菌株),其中革兰阴性菌159株(62.11%),革兰阳性菌75株(29.30%),真菌22株(6.10%)。革兰阴性菌主要是大肠杆菌(27.73%)、肺炎克雷伯菌(8.98%)、铜绿假单胞菌(8.59%),革兰阳性菌主要是屎肠球菌(17.19%),真菌主要是白色念珠菌(4.30%)。大肠杆菌除对头孢替坦敏感外,对其他三代头孢类抗生素耐药率较高,对碳青霉烯类、阿米卡星敏感率高,达到90%以上。肺炎克雷伯菌对厄他培南、头孢替坦、头孢吡肟、阿米卡星、哌拉西林/他唑巴坦敏感率均大于90%,对氨苄西林耐药率100%。铜绿假单胞菌对阿米卡星、庆大霉素绝对敏感。屎肠球菌对克林霉素耐药率100%,未发现耐万古霉素的屎肠球菌。11株白色念珠菌均对氟康唑、伏立康唑、伊曲康唑、两性霉素B高度敏感。结论肠杆菌科和肠球菌科细菌是我院ICU病房腹水感染的主要致病菌,抗生素耐药状况比较严重,通过合理选择抗菌药物,减少耐药菌株的出现,对于临床指导用药具有重要意义。

Objective To investigate the profile and antibiotic resistance of bacteria in patients with ascites in intensive care unit(ICU),and to provide a reference ofrational clinical use of antibiotics.Methods The pathogenic bacteria were isolated and subjected to drug sensitivity test on ascites specimens submitted for clinical examination from January 2012 to December 2019,and relevant data were collected.The clinical distribution characteristics of pathogenic bacteria from positive specimens and their drug resistance were further analyzed and summarized.Results A total of 256 positive samples were detected, including 159 strains of Gram-negative bacteria(62.11%),75 strains of Gram-positive bacteria(29.30%),and 22 strains of fungi(8.59%).The Gram-negative bacteria were mainly Escherichia coli(27.73%),Klebsiella pneumoniae(8.98%)and Pseudomonas aeruginosa(8.59%),the Gram-positive bacteria were mainly Enterococcus faecium(17.19%),and the fungi were mainly Candida albicans(4.30%).In addition to cefotetan, the resistance rate of Escherichia coli to other three generations of cephalosporins was relatively high, and the sensitivity rate to carbapenems and amikacin was more than 90%.The sensitivity rate of Klebsiella pneumoniae to ertapenem, cefotetan, cefepime, amikacin and piperacillin/tazobactam is more than 90%.The resistance rate of Klebsiella pneumoniae to ampicillin was 100%.Pseudomonas aeruginosa was absolutely sensitive to amikacin and gentamicin.The resistance rate of Enterococcus faecalis to clindamycin was 100%,and vancomycin-resistant Enterococcus faecalis was not found.All 11 strains of Candida albicans were highly sensitive to fluconazole, voriconazole, itraconazole and amphotericin B.Conclusion Bacteria in Enterobacteriaceae and Enterococcus are the main pathogenic bacteria of ascites infection in ICU of our hospital, and antibiotic resistance is serious.Reasonable selection of antimicrobial agents and reducing the emergence of drug-resistant strains are of great significance for clinical medication guidance.