重症监护室致病菌分布及其耐药性的分析  

Bacterial distribution and antibiotic resistance in intensive care units

作　　者：叶国强[1] 钟馥霞[1] 向开富[1] 刘香萍[1] 

机构地区：[1]深圳市宝安区人民医院检验科,广东深圳518101

出　　处：《广州医学院学报》2012年第6期75-78,共4页Academic Journal of Guangzhou Medical College

摘　　要：目的:探讨重症监护室(ICU)病原菌的分布及其耐药情况,为临床合理用药提供参考。方法:收集2008年1月至2010年12月广东省深圳市宝安区人民医院ICU患者的标本(包括呼吸道分泌物、创伤部位脓液、尿液和血液)388例,进行细菌培养鉴定和药敏分析。结果:共分离出病原菌93株,其中革兰阴性菌分离出69株,占74.2%;革兰阳性菌20株,占21.5%;真菌4株,占4.3%。检出的革兰阴性菌中,肺炎克雷伯菌最常见,其次为大肠埃希菌和铜绿假单胞菌;检出的革兰阳性菌中,按分离率排列从高到低依次为:葡萄球菌属、链球菌属和肠球菌属。检出的常见革兰阴性菌对亚胺培南敏感率在85.0%～100.0%之间,铜绿假单胞菌对环丙沙星、头孢他啶的敏感率分别为79.0%和89.0%,除粪肠球菌外,革兰阳性菌对万古霉素的敏感率均为100.0%。结论:革兰阴性菌是ICU患者感染的重要致病微生物,应引起临床高度重视。对于革兰阴性菌感染的ICU住院患者,首选亚胺培南等碳青酶烯类抗生素进行抗感染治疗。对ICU患者革兰阳性菌感染,敏感性最好的抗菌药物是万古霉素。Objective：To determine the bacterial distribution and antibiotic resistance in intensive care unit （ICU）, and to offer clues for clinically rational treatment. Methods： Bacteria isolated from 388 specimens （including respiratory secretion, wound secretion, urine and blood） in patients in ICU, Shenzhen Bao＇ an People＇s Hospital, between January 2008 and December 2010, were subjected to identification and drug susceptibility test. Results： Of 93 strains isolated, 69 （74.2%） were Gram-negative bacteria, 20 （21.5%） were Gram-positive bacteria and 4 （4.3%） proved fungi. The most common pathogen of Gram-negative bacteria was klebsiella pneumoniae, followed by Escherichia coli and Pseudomonas aeruginosa. The common Gram- positive pathogen followed the sequence of Staphylococci, Streptococci and Enterococci. 85.0-100.0% of the common Gram-negative bacteria appeared sensitive to imipenem, whilst 79.0% and 89.0% of Pseudomonas aeruginosa strains were sensitive to ciprofloxacin and ceftazidime. All Gram-positive bacteria, with exception of Enterococcus faecalis, proved sensitive to vaneomycin. Conclusions： Gram-negative bacteria account for the crucial pathogenous microorganisms in ICU and deserve specialist alert. Hospitalized patients with refractory Gram-negative bacterial infection in ICU should be treated with carbapenem, i.e. imipenem. Vancomycin proves the optimal antibiotic for the treatment of Gram-positive bacteria infection.

关 键 词：细菌 耐药性 重症监护室 

分 类 号：R446.5[医药卫生—诊断学]