重症监护病房的病原调查及耐药性监测研究  

Distribution and drug resistance of pathogenic bacteria isolated from Intensive Care Units

作　　者：杨雪静[1] 张伟珍[1] 曹俊敏[1] 王原[1] 

机构地区：[1]浙江中医药大学附属第一医院检验科,浙江杭州310006

出　　处：《中国微生态学杂志》2012年第1期52-56,59,共6页Chinese Journal of Microecology

摘　　要：目的调查浙江中医药大学附属第一医院重症监护病房(ICU)临床分离株的病原分布及细菌耐药状况,并与非ICU相比较,观察二者的区别,为临床用药提供有效的参考价值。方法收集该院2010年1月至2011年6月临床送检的各类标本,采用VITEK-2 compact全自动微生物鉴定仪,用GPI、GNI、ANC、YST鉴定卡、AST-GN13、AST-GP67药敏卡进行菌株的鉴定和药敏,根据美国临床实验室标准化协会(CLSI 2010)制定的指导原则,判断细菌的耐药率。结果共计分离到2 341株细菌,其中ICU有505株占21.6%,非ICU有1 836株占78.4%。在ICU分离到的细菌中,革兰阳性菌占23.2%(117/505);非发酵菌占47.3%(239/505)。在非ICU中,革兰阳性菌占34.4%(632/1836);非发酵菌20.2%(371/1836)。ICU前3位细菌分别为鲍曼不动杆菌、肺炎克雷伯杆菌、洋葱伯克霍尔德菌。非ICU前3位依次为大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌。非发酵菌中,铜绿假单胞菌和鲍曼不动杆菌对哌拉西林/他唑巴坦、头孢他啶、头孢吡肟、亚胺培南、美洛培南的耐药率,ICU和非ICU差异有统计学意义(P<0.05)。亚胺培南对ICU铜绿假单胞中的MIC50是非ICU的8倍,MIC90值相当。ICU与非ICU分离的葡萄球菌属细菌对头孢唑啉、环丙沙星、左旋氧氟沙星的耐药率差异有统计学意义(P<0.05)。ICU和非ICU葡萄球菌对利奈唑胺、万古霉素、替考拉宁全部敏感。结论 ICU患者分离的细菌以革兰阴性菌为主,其中又以非发酵菌占大多数。非ICU患者分离的革兰阳性菌比例明显要比ICU高。在主要的致病菌中,ICU的耐药率明显高于非ICU。Objective To investigate the distribution and the resistance rates of bacteria isolated from intensive care u- nits （ICUs） in the First Affiliated Hospital of Zhejiang Chinese Medical University and compare with those isolated from non- ICUs, and provide valuable reference for chnical medication. Method The samples from January 2010 to June 2011 were col- lected. Strains were identified with VITEK-2 compact, and GPI, GNI, ANC, YST, AST-GN13, AST-GP67 were used to detect strains, respectively. The resistance to antimicrobial agents were tested according to the guidelines of CLSI （2010）. Result A total of 2 341 strains were isolated, 21.6% of which were from ICUs while 78.4% from non-ICUs. Of the strains from ICUs, 23.2% （117/505） was Gram-positive bacteria, 47.3% （239/505） was non fermenters bacteria. Of the strains from non-ICUs, 34.4% （632/1836） was Gram-positive bacteria, 20.2% （371/1836） was non fermenters bacteria. The most com- mon pathogens from ICUs were Acinetobacter baumanni, Klebsiella pneumonia and Burkholderia cepacia, while those from non- ICUs were Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa. The resistant rates of Acinetobacter baumanni and Pseudomonas aeruginosa to Piperacillin/Tazobactam, Ceftazidime, Cefepime, Imipenem and Meropenem were significantly different between ICUs and non-ICUs. The MICso values of the isolates from ICUs to Imipeuem were 8 times higher than those from non-lCUs , but the MICgo values were similar. The resistance rate of S. aureusfrom 1CUs to Cefazolin, Ciprofloxacin and Levofloxacin were significantly higher than those from non-ICUs （ P 〈 0. 05 ）. Staphylococcus were sensitive to Vancomycin , Teicoplanin and Liuezolid in both ICUs and non-ICUs. Conclusion Most of the pathogenic bacteria isolated from ICUs are Gram-negative bacteria, with non-fermentation bacteria being dominant. The incidence rate of Gram-positive bacteria from non-ICUs are higher than that from ICUs. Among the major pathogenic bacteria, the resistant

关 键 词：重症监护病房 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]