ICU多重耐药菌定植调查及耐药性分析  

Colonization and drug-resistance of multidrug-resistant bacteria in intensive care unit

作　　者：陈振华[1] 刘文恩[1] 邹明祥[1] 吴安华[1] 艾宇航[1] 

机构地区：[1]中南大学湘雅医院,湖南长沙410008

出　　处：《中国感染控制杂志》2010年第3期155-159,共5页Chinese Journal of Infection Control

摘　　要：目的了解某院重症监护室(ICU)患者体内多重耐药菌的定植情况和耐药特点。方法应用细菌学监测的方法对2008年11月-2009年4月入住该院ICU的82例患者鼻前庭拭子和直肠拭子进行筛查培养,并做药敏试验。采用WHONET5.4软件进行数据分析。结果在38例患者标本中检测到多重耐药菌,定植率为46.34%。包括62株产超广谱β-内酰胺酶(ESBLs)肠杆菌科细菌和4株耐甲氧西林金黄色葡萄球菌(MRSA),未检测到多重耐药的鲍曼不动杆菌和铜绿假单胞菌。62株产ESBLs肠杆菌科细菌对亚胺培南、美罗培南耐药率(4.84%)低,对其他抗菌药物耐药率较高,不同细菌耐药情况不尽相同;4株MRSA除对万古霉素、替考拉宁、利奈唑胺完全敏感,对克林霉素、磷霉素和庆大霉素部分敏感外,对其他抗菌药物均耐药。结论该院ICU患者体内多重耐药菌定植率高,耐药现象严重,应引起临床医生的高度重视,加强监测,避免多重耐药菌在医院暴发流行。Objective To understand the colonization and resistance characteristics of multidrug-resistant bacteria isolated from ICU patients. Methods Nasal vestibular and rectal swabs of 82 patients admitted in a hospital ICU from November, 2008 to April, 2009 were screened by bacteriological surveillance method, and antimicrobial susceptibility were performed. Data were analyzed by WHONETS. 4 software. Results Multidrug-resistant strains were detected among 38 patients , the colonization rate was 46. 34%, which including 62 strains of extended-spectrum β lactamases （ESBLs）- producing Enterobacteriaceae bacteria and 4 strains of methicillin-resistant Staphylococcus aureus （MRSA）, and multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa was not detected. 62 strains of ESBLs-producing strains had lower drug-resistant rates （4. 84%o） to imipenem and meropenem, but had high sensitive rates to the other antimicrobial agents, resistant rates varied with different bacteria; 4 MRSA strains were all sensitive to vancomycin, teicoplanin and linezolid, some were sensitive to clindamycin, fosfomyein and gentamicin, and all were resistant to other antimicrobials. Conclusion Colonization rate of multidrug-resistant bacteria is high in patients in ICU, and drug-resistance is serious, which should be paid attention by clinicians , surveillance should be intensified , so as to avoid the outbreak of multidrug-resistant bacteria infection in hospital.

关 键 词：重症监护室 抗药性 微生物 多重耐药 定植菌 医院感染 ESBLS MRSA 

分 类 号：R181.32[医药卫生—流行病学]