重症监护病房细菌耐药性监测  

Surveillance of drug resistance of pathogens isolated from ICU

作　　者：邹明祥[1] 范学工[2] 钟白云[1] 张国欢[3] 刘文恩[1] 李宪[1] 

机构地区：[1]中南大学湘雅医院检验科,湖南长沙410008 [2]中南大学湘雅医院传染科,湖南长沙410008 [3]中南大学医学技术与情报学院医学检验系,湖南长沙410013

出　　处：《中国医学工程》2006年第3期237-240,共4页China Medical Engineering

摘　　要：目的了解湘雅医院重症监护病房(ICU)临床分离病原菌的分布及其对抗菌药物的耐药性,为临床经验性使用抗菌药物提供依据。方法对该院ICU2003年1月￣2005年12月分离病原菌的分布及耐药情况进行回顾性分析。结果共分离出847株病原菌,其中革兰阴性杆菌573株(67.7%),以铜绿假单胞菌为主(16.5%);革兰阳性球菌265株(占31.3%),以凝固酶阴性葡萄球菌(CNS)为主(13.6%);其它棒状杆菌及真菌9株(1.1%)。呼吸道标本分离病原菌以非发酵菌为主,占43.1%;血液标本以微球菌为主,占41.7%;革兰阴性菌对美罗培南敏感性较高,耐药率为1.1%～12.5%。革兰阳性球菌对万古霉素高度敏感,耐药率为0%～2.7%。鲍曼不动杆菌和铜绿假单胞菌对6种常用抗菌药物的耐药率超过了50.0%;耐甲氧西林金黄色葡萄球菌(MRSA)和凝固酶阴性葡萄球菌(MRCNS)分别高达95.8%和82.6%。结论该院ICU分离病原菌以革兰阴性杆菌为主,尤以铜绿假单胞菌常见。病原菌多重耐药十分严重。及时监测ICU病房细菌分布及耐药性对指导临床选用抗菌药物十分重要。[Objective] To investigate the distribution and drug resistance of the pathogens from intensive care unit（ICU） of Xiangya Hospital, and provide the evidence for using antibiotic rationally in clinics. [Methods] A retrospective analysis was made for the distribution and drug resistance situation in ICU of our hospital from January 2003 to December 2005. [Results] 847 strains were isolated, including 573 G^- bacilli（67.7%） and 265 G^＋ cocci （31.3%） and 9 Corynebacterium and fungi （1.1%）. The main G^- and G^＋ bacteria were Pseudomonas aeruginosa （16.5%） and Coagulase-negative staphylococcus（13.6%）. The most common pathogens in respiratory trat specimens were nonfermenters（43.1%）. The most pathogens in blood were Micrococcaceae（41.7%）. Meropenem remains highly active against G^- bacilli and the resistance rate were 1.1%～12.5%. G^＋ cocci were highly sensitive to vancomycin and the resistance rate were 0%～2.7%. Resistant rates of Pseudomonas aeruginosa and Acinetobacter baummmii were more than 50% for six common antibiotics. Among Staphylococcus aureus（SA） and CNS, resistant isolates to methicillin accounted for 95.8% and 82.6% respectively. [Conclusion] The predominant pathogens in ICU are G^-bacilli, especially Pseudomonas aeruginosa. The muhdrug resistance of bacteria is a serious problem. It is very important to monitor the distribution and drug resistance of the pathogens to guide the use of antibiotics.

关 键 词：重症监护病房 病原菌 抗菌药物 耐药性 

分 类 号：R18[医药卫生—流行病学]