贵州省人民医院综合ICU病区临床分离株的耐药及分布特点

The Clinical Isolate Resistance and Distribution Characteristics of Intesive Care Unit in GuiZhou Provincial People’s Hospital

目的了解ICU病区临床分离菌株耐药性的变迁,为临床合理用药提供依据。方法收集2014—2019年间ICU病区患者送检标本的细菌培养及体外药敏试验数据,使用WHONET5.6软件对数据进行统计分析。结果 2014—2019年共分离出非重复菌2426株,其中革兰阴性菌1894株(78.1%)、革兰阳性菌532株(21.9%);居前5位的革兰阴性菌是鲍曼不动杆菌(26.0%)、肺炎克雷伯菌(16.5%)、大肠埃希菌(12.0%)、铜绿假单胞菌(9.7%)和黏质沙雷菌(3.1%);居前5位的革兰阳性菌是金黄色葡萄球菌(29.3%)、屎肠球菌(21.8%)、粪肠球菌(10.5%)、肺炎链球菌(8.3%)、表皮葡萄球菌(7.0%);标本类型以痰液(70.3%)、血液(12.4%)、分泌物(4.7%)和尿液(2.4%)为主;鲍曼不动杆菌和铜绿假单胞菌对碳青霉烯类药物的耐药率分别>75%和 >20%,肺炎克雷伯菌、大肠埃希菌对碳青霉烯类的药物耐药率分别为>35%和<3%。结论 ICU病区以鲍曼不动杆菌、肺炎克雷伯菌、大肠埃希菌和铜绿假单胞菌为主,近年来肺炎克雷伯菌的分离率明显增高,非发酵菌和肠杆菌科细菌对碳青霉烯类药物的耐药率呈上升的趋势,耐甲氧西林金黄色葡萄球菌的检出率呈逐年下降的趋势加。强医院内感染防控措施及细菌耐药监测,合理使用抗菌药物。

Objective To understand the change of drug resistance of clinical isolates in ICU ward,and to provide basis for clinical rational drug use.Method Data of bacterial culture and in vitro drug sensitivity test of samples submitted by patients in ICU ward from 2014 to 2019 were collected,and statistical analysis was conducted using WHONET5.6 software.Results A total of 2,426 non-repeating strains were isolated from 2014 to 2019,among which 1894 strains were Gram-negative bacteria (78.1%).There were 532 gram-positive strains (21.9%);The top five Gram-negative bacteria were Acinetobacter baumannii (26.0%),Klebsiella pneumoniae (16.5%),Escherichia coli (12.0%),Pseudomonas aeruginosa (9.7%) and Serrella marquis (3.1%).While the top five Gram-positive bacteria were Staphylococcus aureus (29.3%),Enterococcus faecium (21.8%),Enterococcus faecalis (10.5%),Streptococcus pneumoniae (8.3%) and Staphylococcus epidermidis (7.0%).The main specimen type were sputum(70.3%),blood (12.4%),abscess (4.7%) and urine (2.4%);The drug resistance rates of Acinetobacter baumannii and Pseudomonas aeruginosa to carbapenems were more than 75% and 20%,respectively,The drug resistance rates of Klebsiella pneumoniae and Escherichia coli to carbapenems were respectively more than 35% and less than 3%.Conclusions Acinetobacter baumannii,Klebsiella pneumoniae,Escherichia coli and Pseudomonas aeruginosa were the main isolates in ICU ward.In recent years,the isolation rate of Klebsiella pneumoniae has increased significantly,The resistance rate of non-fermentative bacteria and Enterobacteriaceae bacteria to carbapenems showed an increasing trend,and the detection rate of methicillin-resistant Staphylococcus aureus showed a decreasing trend year by year.Strengthen nosocomial infection prevention and control measures and bacterial drug resistance monitoring,rational use of antimicrobial drugs.