重症监护病房常见非发酵菌的分布及耐药性分析  

Distribution and Antibiotic Resistance of Three Common Nonfermenters Causing Nosocomial Infection in ICU

作　　者：兰会华[1] 郭世辉[1] 梁宏洁[1] 莫武宁[1] 

机构地区：[1]广西医科大学第一附属医院临床医学实验部,广西南宁530021

出　　处：《中华医院感染学杂志》2010年第13期1957-1959,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨重症监护病房(ICU)常见非发酵菌的分布及耐药情况,以指导临床合理使用抗菌药物。方法采用ATB Expression细菌鉴定仪进行菌种鉴定,药敏试验采用K-B纸片扩散法,用WHONET 5.3软件进行数据的统计和分析。结果 2005-2008年医院ICU感染患者共分离出革兰阴性杆菌1695株,其中鲍氏不动杆菌最多见(25.9%),其次是铜绿假单胞菌(22.5%),嗜麦芽寡养单胞菌排第5位(10.6%);这些菌株大多数分布在呼吸系统标本,而非ICU菌株除呼吸系统外,尿液、分泌物及血标本也较多;ICU中铜绿假单胞菌、鲍氏不动杆菌和嗜麦芽寡养单胞菌对多种抗菌药物表现为较高的耐药性;ICU分离的铜绿假单胞菌对亚胺培南和美罗培南耐药率为26.3%和27.2%,远远高于非ICU(8.0%和8.5%);鲍氏不动杆菌对哌拉西林、氨曲南、环丙沙星、左氧氟沙星、磺胺甲噁唑/甲氧苄啶的耐药率均>80.0%;在监测的13种药敏纸片中,嗜麦芽寡养单胞菌除对环丙沙星、左氧氟沙星、磺胺甲噁唑/甲氧苄啶较为敏感外,对其他药物的耐药率均>30.0%。结论 ICU中非发酵菌感染所占比率高且耐药率普遍高于普通病房,应加强医院细菌耐药性监测;临床治疗感染应区别对待,合理使用抗菌药物,减少耐药菌的产生。OBJECTIVE To investigate the distribution and antibiotic resistance of common nonfermenters causing nosocomial infection in the patients in surgical intensive care unit（ICU） and provide theoretical bases of rational usage of antibiotics for the clinic.METHODS Bacteria were identified by ATB Expression bacteria analysis system and antibiotic susceptibility test was performed by K-B disk diffusion method.The data were analyzed by using WHONET5.3 software.RESULTS Totally 1695 strains Gram-negative bacilli were isolated from ICU from 2005 to 2008,the most commonly encountered bacteria was Acinetobacter baumannii（25.9%）,the next was Pseudomonas aeruginosa（22.5%）,the fifth rank was Stenotrophomonas maltophilia（10.6%）.The main bacteria in ICU were from sputum and in non-ICU from sputum and urine,secretion mostly.P.acruginosa,A.baumannii and S.maltophilia had high antibiotic resistant rate.The resistant rate of P.aeruginosa isolates from ICU to imipenem and meropenem was 26.3% and 27.2%,higher than from non-ICU（8.0% and 8.5%）;the resistant rate of A.baumannii isolates from ICU to piperacillin,aztreonam,ciprofloxacin,levofloxacin,trimethoprim/sulfamethoxazole were over 80%;the resistant rate of S.maltophilia was over 30% to 13 antibiotic except ciprofloxacin,levofloxacin and trimethoprim/sulfamethoxazole.CONCLUSION The resistant rate of nonfermenters in ICU is higher than in non-ICU.Most of main bacteria in ICU have higher resistance to most antibiotics than in non-ICU.Strengthening the surveillance of drug resistance to provide reliable reference for the clinical reasonable application of antibiotics and to reduce the drug resistance.

关 键 词：重症监护病房 非发酵菌 抗药性 

分 类 号：R378[医药卫生—病原生物学]