ICU患者血流感染病原菌分布特点及耐药性分析  

Distribution and antimicrobial resistance of pathogens causing bloodstream infections in ICU patients

作　　者：李少增[1] 郑鹏强 蔺静[1] 蒋伟[1] 于勇[1] 

机构地区：[1]解放军总医院第一附属医院检验科,北京100048

出　　处：《中华医院感染学杂志》2013年第21期5332-5334,共3页Chinese Journal of Nosocomiology

基　　金：军队十二五重大科研基金资助项目(AWS11J0083)

摘　　要：目的了解医院ICU患者血流感染(bloodstream infections,BSI)病原菌分布特点及耐药性,指导临床合理使用抗菌药物。方法采用VITEK-2Compact全自动微生物分析仪对2007年1月-2012年12月分离自ICU血液标本的细菌培养结果进行鉴定及药敏分析。结果在817例BSI标本中共分离出199株不重复病原菌,检出阳性率为24.4%;其中革兰阳性菌75株占37.7%,革兰阴性菌104株占52.3%,真菌20株占10.0%,革兰阳性菌以金黄色葡萄球菌为主,革兰阴性菌以洋葱伯克霍尔德菌、大肠埃希菌以及鲍氏不动杆菌为主;在肠杆菌科细菌中发现8株耐碳青霉烯类菌株;真菌以白色假丝酵母菌为主,对常用抗真菌药均较敏感。结论医院ICU血流感染分离的病原菌分布比较广,耐药性差异较大,其中耐药性很强的金黄色葡萄球菌、鲍氏不动杆菌、洋葱伯克霍尔德菌是BSI的主要病原菌,也是临床抗感染治疗的难点,同时也要重点关注耐碳青酶烯类肠杆菌科细菌。OBJECTIVE To understand the distribution and drug resistance of pathogens causing bloodstream infections in the ICU patients so as to guide the reasonable clinical use of antibiotics. METHODS The identification of the pathogens isolated from the ICU blood specimens from Jan 2007 to Dec 2012 was performed with the use of VITEK-2 Compact automatic microorganism analyzer, then the drug susceptibility testing was carried out. RESULTS Totally 199 strains of non-repetitive pathogens have been isolated from the specimens obtained from 817 cases of bloodstream infections with the detection rate of 24.4%, among which there were 75 （37.7%） strains of gram-positive bacteria, 104 （52. 3%） strains of gram-negative bacteria, and 20 （10.0%） strains of fungi; the Staphylococcus aureus was the predominant species of gram-positive bacteria, while Burkholderia cepacia, Acinetobacter baumannii, and Escherichia coli were dominant among the gram-negative bacteria; totally 8 strains of carbapenem-resistant Enterobacteriaceae have been isolated; the Candida albicans was the predominant species of fungi and was susceptible to the commonly used antifungal drugs. CONCLUSION The pathogens causing bloodstream infections in the ICU patients are widely distributed and vary significantly in drug resistance; the major species of pathogens including S. aureus, A. baumannii, and B. cepacia are highly resistant, which makes the clinical treatment of infections more difficult, and it is necessary to attach great importance to the carbapenem- resistant Enterobacteriaceae isolates.

关 键 词：重症监护病房 血流感染 病原菌 分布 耐药性 

分 类 号：R378[医药卫生—病原生物学]