重症监护室院内感染细菌分布及其耐药性变迁  

Bacterial distribution and drug resistance change of nosocomial infection in intensive careunit

作　　者：郑伟浩[1] 伍国达[1] 张丽珊[1] 赵英萍[1] 

机构地区：[1]广东省江门市中心医院重症医学科,529030

出　　处：《中国实用医刊》2012年第9期30-35,共6页Chinese Journal of Practical Medicine

摘　　要：目的探讨重症监护室院内感染细菌的分布及其耐药情况的变化趋势。方法对2008年1月至2010年12月广东省江门市中心医院重症医学科院内感染的细菌及其耐药情况进行统计分析。结果37．1％的院内感染为革兰阳性（G-）菌，62．9％为革兰阴性（G-）菌，其中大约81．3％为下呼吸遭感染。在G-菌中，金黄色葡萄球菌占38．9％，表皮葡萄球菌、溶血葡萄球菌各占19．5％；葡萄球菌属对糖肽类、利奈唑胺和奎奴普丁／达福普汀保持100％敏感率，除了氯霉素、复方新诺明对金葡菌的耐药率较低外，其他药物的耐药率均很高，超过60％；凝固酶阴性葡萄球菌的耐药率更高。在G一菌中，阴性杆菌占20％，非发酵菌占50％，并且，鲍曼不动杆菌和嗜麦芽窄食单胞菌逐年增多；肺炎克雷伯杆菌对碳青霉烯类和阿米卡星耐药率最低，低于8％，且呈显著下降趋势；对头孢西丁耐药率约20％，对其他抗菌药的耐药率则显著上升；大肠埃希菌对哌拉西林／他唑巴坦、头孢哌酮／舒巴坦、碳青霉烯类和阿米卡星的耐药率低于20％，对头孢菌素类（除头抱西丁外）和喹诺酮类的耐药率整体超过80％。对铜绿假单胞菌耐药率最低的是多粘菌素B，其次是阿米卡星、哌拉西林／他唑巴坦；其他抗菌药耐药率高，但呈显著下降趋势。鲍曼不动杆菌对亚胺培南、米诺环素的耐药率不超过20％；对头孢哌酮／舒巴坦的耐药率最高，超过90％，其次为氨曲南，超过80％；而对其他抗菌药的耐药率低于铜绿假单胞菌。嗜麦芽窄食假单胞菌对米诺环素的耐药率最低（〈10％），其次为复方新诺明、左旋氧氟沙星，耐药率低于36．4％，对其他药物的耐药率均很高。结论ICU院内细菌感染以G-菌为主，鲍曼不动杆菌、嗜麦芽窄食单胞菌显著增多；整体细菌耐药率高，且绝大多数为多重耐药菌�Objective To investigate the bacterial distribution and the changing trend of drug re- sistance in intensive care unit. Methods Bacterial distribution and antimicrobial resistant results of nos- ocomial infection in department of ICU, Jiangmen Central Hospital, between January 2008 and December 2010 were analyzed statistically. Results The 37.1% of nosocomial infections were Gram-positive（ G ＋ ） bacteria, 62.9% were Gram-negative（G- ） bacteria, and about 81.3% of which were lower respiratory tract infections. Among G＋ bacteria, staphylococcus aureus accounted for 38.9%, staphylococcus epi- dermidis and staphylococcus haemolyticus accounted for 19.5%, respectively; The sensitive rates of staphylococcus to glycopeptide, linezolid and quinupristin/dalfopristin maintained 100%, except cblor- amphenicol and cotrimoxazole, the resistance rates of S. aureus to other drugs were very high, more than 60% ; and the resistant rate of coagulase-negative staphylococci was more higher. Among G- bacteria, gram-negative bacilli accounted for 20%, and non-fermentative bacteria accounted for 50%, moreover, acinetobacter baumannii and stenotrophomonas mahophilia were increasing year by year. The resistance rates of Klebsiella pneumoniae to carbapenem and amikacin were the lowest, less than 8%, and which significant decreased; Resistance to cefoxitin was about 20%, and the other antimicrobial agents in- creased significantly. The resistance rates of Escherichia coli to piperacillin / tazobactam, cefoperazone / sulbactam, carbapenems and amikacin were below 20%, resistance rates to cephalosporins（ except cefox- itin） and quinolone were more than 80%. The lowest resistance rate to Pseudomonas aeruginosa was Pol- ymyxin B, followed by was amikacin, piperacillin / tazobactam, the resistance rates of other antibiotic were very high, but showed a significant decline trend. The resistance rates of acinetobacter baumannii to imipenem and minocycline were no more than 20% ; resistances to cefoperazone / sulbactam were thehighe

关 键 词：医院感染 细菌 抗菌药物 抗药性 

分 类 号：R446.5[医药卫生—诊断学]