2018—2021年成都某基层医院重症监护室病原菌分布及耐药性变迁分析

Analysis on the distribution and drug resistance of pathogenic bacteria in intersive careunit of a primary hospital in Chengdu from 2018 to 2021

目的了解成都某基层医院近4年重症监护病房(ICU)病原菌临床分布及耐药性变迁,为临床合理选用抗菌药物、延缓多重耐药菌产生提供依据。方法收集2018年1月—2021年6月ICU病区分离的病原菌资料,采用WHONET 5.6软件进行药敏数据分析。结果共分离出436株病原菌,其中革兰阳性菌64株,革兰阴性菌372株;构成比居前5位的病原菌分别是克雷伯菌属(27.06%)、鲍曼不动杆菌(16.74%)、铜绿假单胞菌(16.28%)、金黄色葡萄球菌(9.63%)和大肠埃希菌(8.72%);ICU鲍曼不动杆菌呈高耐药性,对青霉素类、头孢菌素类和碳青霉烯类抗菌药物耐药率均>65%;耐甲氧西林金黄色葡萄球菌(MRSA)检出率为16.67%,未发现利奈唑胺和万古霉素耐药株。结论被调查医院ICU患者感染的病原菌以鲍曼不动杆菌和铜绿假单胞菌居多,且多重耐药菌检出率逐年增高,应加强病原菌监测,关注新型抗菌药物研发进展,提高临床精准抗感染能力。

Objective To understand the clinical distribution and drug resistance changes of intersive careunit(ICU)pathogens in a primary hospital in Chengdu in the past 4 years,so as to provide a basis for the rational selection of antibacterial drugs in the clinic and delay the emergence of multi-drug-resistant bacteria.Methods Data isolated from ICU ward from January 2018 to June 2021 were collected,and drug susceptibility data were analyzed using WHONET 5.6 software.Results A total of 436 strains of pathogenic bacteria were isolated,including 64 Gram-positive strains and 372 Gram-negative strains.The top five pathogens in the composition ratio were Klebsiella trevisan(27.06%),Acinetobacter baumannii(16.74%),Pseudomonas aeruginosa(16.28%),Staphylococcus aureus(9.63%),and Escherichia coli(8.72%).Acinetobacter baumannii in the ICU ward that showing high resistance,and the resistance rates to penicillins,cephalosporins and carbapenems were greater than 65%.The detection rate of MRSA was 16.67%,and linezolid and vancomycin-resistant strains were not found.Conclusion Acinetobacter baumannii and Pseudomonas aeruginosa are the most infected bacteria in ICU patients in the investigated hospital,and the detection rate of multi-drug resistant bacteria is increasing year by year.The pathogen monitoring should be strengthened,and the research and development of new antibiotics should be paid attention to,and clinical precise anti-infection treatment should be promoted.