江西省某三甲医院2012—2020年ICU病房细菌耐药性监测

Surveillance of Bacterial Drug Resistance in ICUs of a GradeⅢLevel A Hospital in Jiangxi Province,2012-2020

目的研究南昌大学第一附属医院2012—2020年ICU细菌感染的病原菌分布及耐药性,为抗菌药物合理使用提供数据支持。方法回顾性分析南昌大学第一附属医院2012—2020年ICU送检标本的微生物培养结果,采用Vitek 2 Compact全自动微生物检测系统进行菌种鉴定和药物敏感性分析,补充药敏试验采用纸片扩散法(K-B法)或E-Test法进行。结果2012—2020年南昌大学第一附属医院ICU科室共分离22064株病原菌,其中革兰阴性菌占79.9%,革兰阳性菌占20.1%;革兰阴性菌以鲍曼不动杆菌(22.4%)、肺炎克雷伯菌(18.7%)、铜绿假单胞菌(10.7%)为主,阳性菌以金黄色葡萄球菌(4.8%)、表皮葡萄球菌(3.5%)、屎肠球菌(2.4%)为主;病原菌主要分离自神经外科ICU(30.8%)、综合ICU(22.7%)和急诊科ICU(12.0%),以呼吸道(68.6%)、血液(13.1%)及尿液标本来源为主(5.6%);耐药性监测结果显示,耐碳青霉烯类鲍曼不动杆菌、耐碳青霉烯类肺炎克雷伯菌、耐碳青霉烯类铜绿假单胞菌及耐碳青霉烯类大肠埃希菌的检出率依次为87.2%、45.6%、49.2%、13.6%,耐苯唑西林金黄色葡萄球菌和耐苯唑西林表皮葡萄球菌检出率分别为50.1%和86.8%,革兰阴性菌对替加环素菌保持较高的敏感性,革兰阳性菌对万古霉素、利奈唑胺、奎奴普丁/达福普汀保持较好的敏感性;不同ICU科室抗菌药物耐药情况存在差异,烧伤科ICU病原菌耐药率明显高于其他科室,常见革兰阴性菌碳青霉烯类耐药率呈现渐变上升趋势。结论ICU分离的病原菌以革兰阴性杆菌为主且对抗菌药物耐药率日益增加,不同科室ICU设置会导致病原菌耐药性存在差异,易促进多重耐药菌的产生及流行。需加强不同ICU病区的细菌耐药监测,制定合理的抗感染方案并加强院感防控措施。

Objective To investigate the distribution and drug resistance of clinically isolated pathogens in the intensive care units(ICUs)of the First Affiliated Hospital of Nanchang University from 2012 to 2020,and to provide a basis for rational use of antibiotics.Methods Bacterial culture resultsof ICU samples from the First Affiliated Hospital of Nanchang University from 2012 to 2020 were retrospectively analyzed.The Vitek 2 Compact automatic system was used for microbial identification and drug sensitivity analysis.Kirby-Bauer disk diffusion or E-test was conducted for supplementary drug susceptibility test.Results A total of 22064 strains of pathogens were isolated from the ICUs of the First Affiliated Hospital of Nanchang University from 2012 to 2020,of which 79.9%were Gram-negative bacteria and 20.1%were Gram-positive bacteria.The top three isolates of Gram-negative bacteria were Acinetobacter baumannii(22.4%),Klebsiella pneumoniae(18.7%),and Pseudomonas aeruginosa(10.7%).The top three isolates of Gram-positive bacteria were Staphylococcus aureus(4.8%),Staphylococcus epidermidis(3.5%),and Enterococcus faecium(2.4%).The isolates were mainly distributed in neurosurgery ICU(30.8%),comprehensive ICU(22.7%)and emergency ICU(12.0%),and were mainly derived from respiratory tract(68.6%),blood(13.1%)and urine samples(5.6%).The detection rates of carbapenem-resistant Acinetobacter baumannii,Klebsiella pneumoniae,Pseudomonas aeruginosaand Escherichia coli were 87.2%,45.6%,49.2%and 13.6%,respectively.The detection rates of oxacillin-resistant Staphylococcus aureus and Staphylococcus epidermidis were 50.1%and 86.8%,respectively.Gram-negative isolates were susceptible to tigecycline,while Gram-positive isolates were sensitive to vancomycin,linezolid and quinupristin/dalfopristin.There were differences in antimicrobial resistance among different ICUs.The resistance rate of pathogenic bacteria in burn ICU was significantly higher than that in other ICUs.The detection rate of carbapenem-resistant Gram-negative isolates showed an upward trend.Conclusion Gram-negative bacilli are primary pathogens isolated from ICUs,and their resistance to antibiotics is increasing.The setting of different ICUs leads to differences in drug resistance of pathogens,which easily promote the generation and prevalence of multi-drug resistant bacteria.The surveillance of bacterial drug resistance in different ICUs should be strengthened,so as to formulate reasonable anti-infection programs and prevention and control measures for nosocomial infections.