ICU患者病原菌分布及耐药性分析  

Pathogens distribution and resistance analysis in infections of patients in intensive care units

作　　者：周运恒[1] 马红霞[2] 石晓星[1] 于军一 刘风华[1] 曹广亚[1] 

机构地区：[1]武警上海总队医院检验科,201103 [2]上海市东方医院,200120

出　　处：《国际检验医学杂志》2011年第7期748-749,752,共3页International Journal of Laboratory Medicine

摘　　要：目的调查2009年该院ICU患者感染的病原菌分布与耐药现状,为临床诊治提供最新的依据。方法对ICU送检的538例标本进行病原菌分离、鉴定和耐药性分析。结果 538例标本中,以痰和引流管为主,共分离329株病原菌,其中革兰阴性杆菌占64.7%,革兰阳性球菌占18.5%,真菌占16.7%;分离率居前4位的依次为肺炎克雷伯菌(20.4%)、铜绿假单胞菌(16.7%)、金黄色葡萄球菌(14.0%)和鲍曼不动杆菌(8.8%)。药敏试验表明,在肺炎克雷伯菌、产气肠杆菌和大肠埃希菌中,耐药率大于80.0%的有阿莫西林、头孢噻吩、头孢呋辛和替卡西林,碳青霉稀类抗生素(亚胺培南和美洛培南)的耐药率均为0.0%,肺炎克雷伯菌和大肠埃希菌ESBLs产酶率分别是77.6%和61.5%;多粘酶素E对铜绿假单胞菌和鲍曼不动杆菌的耐药率最低(0.0%和9.09%);金黄色葡萄球菌和表皮葡萄球菌对万古霉素、替考拉宁、呋喃妥因和夫西地酸的耐药率均为0.0%,MRSA和MRSE分别占82.6%和100.0%;真菌对5种药物的耐药率均小于10.0%。结论该院ICU患者以呼吸道感染为主,革兰阴性杆菌所占比例较高,真菌感染比例上升,多种感染菌呈现多重性耐药,ESBL和MRS比例升高。Objective To investigate pathogens distribution and drug resistance status in intensive care unit（ICU）or our hospital in 2009 ,and to provide the scientific reference for diagnosis and reasonable use of antibiotics. Methods A total of 538 samples were obtained from ICU patients and cultured for differentiation and the resistance results were statistically analyzed. Results There are mainly sputum and drainage tube among 538 specimens, 329 strains were isolated. The results showed that Gram-negative rod made up 64.7 % ,Gram positive coccus and candida strains made us 18.5% and 16.7%. The top 4 of isolating rate were Klebsiella pneu monia（20.4%）, Pseudomonas aeruginosa（ 16.7%）, Staphyloccocus aureus （ 14.0 % ）, Acinetobacter baumanii（8.8 %）. There are 4 kinds of antibiotic, amoxicillin, cefoxitin, cefuroxime and ticarcillin, whose resistance rates to Klebsiella pneumoniae, Enterobacter aerogenes and Escherichia coli were all more than 80.00/00. The resistance rate of the 3 kinds of enteric bacilli to imipenem and meropenem was 0.0 %. The prevalences of ESBLs in Klebsiella pneumoniae and Escberichia coli were 77.6 %and 61.5 %,respectively. The resistance rate of colimycin to Pseudomonas aeruginosa and Acinetobacter baumanii was very lower（0.0% and 9.09%）. The resistance rate of Staphyloccocus aureus to vancomycin, teicoplanin, nitrofurantoin and fusidic acid was all 0.0%. The rate of MRSA and MRSE was 82.6% and 100.0% ,respectively. The resistance rate of candida strains to 5 kinds of anti fungus drugs are all less than 10.0K. Conclusion The respiratory tract are frequent complications in ICU patients of this hospital. Gram-negative bacilli are the mostly infected pathogens. The detection rate of candida strains increased ceaselessly. The multiple resistance of many kinds of bacteria is a serious issue.

关 键 词：重症监护病房 抗药性 细菌 病原菌分布 

分 类 号：R446.5[医药卫生—诊断学]