医院ICU患者检出病原菌的分布及耐药性分析  

Bacterial distribution and resistance in the intensive care units of Guangdong Medical College Affiliated Hospital

作　　者：皇甫长梅[1] 尹小健[1] 佟琳[1] 蔡施霞[1] 林湛[1] 张媛莉[1] 姚华国[1] 

机构地区：[1]广东医学院附属医院重症医学科,广东湛江524001

出　　处：《中国热带医学》2010年第2期186-187,219,共3页China Tropical Medicine

摘　　要：目的监测重症监护病房（ICU）感染病原茵的分布及耐药情况，为临床用药及感染管理提供参考。方法对我院2008年1月-12月ICU送检的各类标本中分离出的病原菌应用法国生物梅里埃公司全自动微生物分析仪VITEK32及配套试剂进行细菌鉴定、药敏试验和产酶菌检测。结果共分离出细菌589株，其中G＋球菌149株（占25．3％），前3位依次是金黄色葡萄球菌、凝固酶阴性葡萄球菌和肠球菌；G-杆菌337株（占57．2％），G-杆菌中以非发酵菌为主，占总阳性菌株的39．7％，前3位依次是铜绿假单胞菌、鲍曼氏不动杆菌、嗜麦芽假单胞菌；真菌103株（占17．5％）。甲氧西林耐药菌株分别占黄色葡萄球菌和凝固酶阴性葡萄球菌的95．1％和98．4％，尚未检出万古霉素耐药菌株。铜绿假单胞菌除多粘菌素B外对所有抗生素的耐药率均超过50％；鲍曼不动杆菌对泰能、美罗培南、哌拉西林，他唑巴坦、头孢哌酮／舒巴坦以外抗生素的耐药率均高于70％；大肠埃希菌和肺炎克雷伯茼产ESBLs株的检出率分别为70．6％和32．0％。结论ICU中检出的病原菌多重耐药性严重，细菌耐药性监测对指导临床经验性选药及抗茵药物管理具有重要意义。Objective To investigate the distribution and drug resisrance of bacteria isolated from Intensive Care Unit （ICU） in our hospital from January 1,2008 to December 31,2008. Methods Bacteria isolated were identified,and their sensitivity to antibiotics were tested by VITEK32. Results Totally 589 strains were isolated included 149 （25.3%） Grampositive strains,337 （57.2%） Gram-negative strains and 103 （17.5%） fungal strains. The rank order of Gram-positive strains was Staphylococcus aureus （ 10.4% ）, coagul ase-negative Staphylococcus （CNS, 10.4% ） and Enterococci （3.2%）. The top three gram-negative rods were Pseudomonas aerug/nosa,Acinetobacter baummannii and Pseudomonas maltophilia. 95.1% and 98.4% of Staphylococcus aureus and CNS were resistant to metieillin. No Staphylococcus strain was resistant to vancomycin.The resistant rates of Pseudomonus aeruginosa to all abtibiotics tested were over 50% excluded polymyxin E. The resistant rates of Cinetobacter baummannii to various abtibiotics were over 70% excluded imipenem,meropenem, piperacillin-tazobactam and cefoperazone-sulbactam. ESBLs positive rates of E.coli and Klebsiella pneumoniae were 70.6% and 32.0%,respectively. Conclusion The status of drug resistance of bacteria in ICU is severe and drug snsitivity test be carried out to guide clinical treatment.

关 键 词：感染 细菌分布 耐药 重症监护病房 

分 类 号：R978.1[医药卫生—药品]