2018—2022年宁德师范学院附属宁德市医院重症医学科患者血流感染病原菌的分布及耐药性分析

Investigation on the distribution and drug resistance of pathogens from patients with bloodstream infection inintensive care unit of Ningde Municipal Hospital of Ningde Normal University from 2018 to 2022

目的 分析宁德师范学院附属宁德市医院重症医学科(ICU)患者血流感染病原菌的分布及耐药情况,以指导ICU病原菌的防控及临床合理用药。方法 以2018年1月—2022年12月宁德市医院ICU患者血培养分离病原菌作为研究对象,分析培养出病原菌的分布特点及对药物的耐药情况。结果 共培养出446株病原菌,其中革兰阴性菌203株(45.52%),革兰阳性菌196株(43.95%),真菌45株(10.09%)。检出率最高病原菌依次是凝固酶阴性葡萄球菌、肺炎克雷伯菌、大肠埃希菌、屎肠球菌和金黄色葡萄球菌。肺炎克雷伯菌对哌拉西林耐药率最高,为78.46%,对亚胺培南和美罗培南耐药率为分别为18.46%、20.00%;大肠埃希菌对哌拉西林及环丙沙星耐药率最高,为81.36%、50.85%,对碳青霉烯类抗生素全部敏感;鲍曼不动杆菌对头孢哌酮/舒巴坦和美罗培南耐药率分别为42.86%、50.00%;铜绿假单胞菌对亚胺培南和美罗培南耐药率分别为21.43%、28.57%;凝固酶阴性葡萄球菌对青霉素类抗生素耐药率最高,为94.12%,对阿奇霉素、红霉素及左氧氟沙星耐药率较高,达50.00%以上;金黄色葡萄球菌对青霉素耐药率为100.00%,对万古霉素全部敏感;屎肠球菌对高浓度庆大霉素耐药率为28.00%;粪肠球菌对高浓度庆大霉素耐药率为56.25%。结论 宁德师范学院附属宁德市医院ICU患者血流感染感染病菌种类繁多,以凝固酶阴性葡萄球菌和肺炎克雷伯菌为主。病原菌对药物耐药率较高,应引起临床重视并合理应用抗菌药物。同时加强院内感染的防控工作,减少或延缓耐药株的出现。

Objective To analyze the distribution and drug resistance of pathogenic bacteria from patients with bloodstream infection in ICU, so as to guide the prevention of pathogens and rational drug use. Methods The study objects were pathogens isolated from blood cultures of ICU patients from January 2018 to December 2022, the distribution characteristics of pathogens and their resistance to antibiotics were analyzed. Results A total of 446 pathogenic bacteria were isolated, included 203 gram-negative bacteria (45.52%), 196 gram-positive bacteria (43.95%), and 45 fungi (10.09%). The top five pathogens were coagulase negative Staphylococci, Klebsiella pneumonia, Escherichia coli, Enterococcus faecium, and Staphylococcus aureus. Klebsiella pneumonia had the highest resistance rate to piperacillin (78.46%), the resistance rates to imipenem and meropenem were 18.46% and 20.00%, respectively. The resistance rates of Escherichia coli to piperacillin and ciprofloxacin were the highest (81.36% and 50.85%), all of them were sensitive to carbapenem. The resistance rate of Acinetobacter baumannii to cefoperazone/sulbactam and meropenem were 42.86% and 50.00%, respectively. The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 21.43% and 28.57%, respectively. The resistance rate of Coagulase negative Staphylococci to penicillin antibiotics was the highest (94.12%), and the resistance rate to azithromycin, erythromycin and levofloxacin was more than 50.00%. The resistance rate of Staphylococcus aureus to penicillin was 100%, all of them were sensitive to vancomycin. The resistance rate of Enterococcus faecium to high concentration gentamicin was 28.00%. The resistance rate of Enterococcus faecalis to high concentration gentamicin was 56.25%. Conclusion The most common bacteria are coagulase negative Staphylococci and Klebsiella pneumonia in ICU, and most of the bacteria have high drug resistance, so clinical doctors should use antibiotics reasonably. Hospital staff should strengthen the prevention and control of hospital infections, reduce or delay the emergence of drug resistant strains.