重症监护病房病原菌分布及耐药性分析  

Bacteria distribution and drug resistance in intensive care unit

作　　者：郭主声[1] 朱学海[1] 林偲思[1] 张丽华[1] 张丽[1] 谢树金 

机构地区：[1]中山大学附属东华医院检验科,广东东莞523110

出　　处：《国际检验医学杂志》2014年第3期286-289,共4页International Journal of Laboratory Medicine

摘　　要：目的回顾性研究重症监护病房(ICU)患者常见病原菌分布及变迁,为合理使用抗菌药物、有效控制感染提供依据。方法对该院ICU2006年1月至2011年12月的所有分离菌株,采用VITEK32全自动微生物分析仪鉴定细菌,用纸片扩散法(K-B法)对常用抗菌药物进行耐药性分析。结果共分离1531株细菌,革兰阴性杆菌共868株(56.7%),革兰阳性菌381株(24.9%),真菌225株(14.7%)。所占比例排前5位的革兰阴性杆菌分别是肺炎克雷伯菌(13.3%)、鲍曼不动杆菌(12.1%)、大肠埃希菌(9.7%)、铜绿假单胞菌(7.8%)、嗜麦芽寡养单胞菌(3.0%)。所占比例排前5位的革兰阳性球菌分别是金黄色葡萄球菌(8.6%)、溶血性葡萄球菌(3.3%)、表皮葡萄球菌(3.1%)、粪肠球菌(2.3%)、肺炎链球菌(1.9%)。革兰阴性杆菌对第三代头孢菌素耐药率较高,对亚胺培南保持较高的敏感性;未发现对万古霉素不敏感的葡萄球菌。结论 ICU病房感染的细菌仍以革兰阴性杆菌为主,革兰阳性菌感染率有上升趋势。细菌耐药率高,用细菌耐药性检测结果指导临床用药可以控制耐药菌的产生。Objective To study the alteration of microbial population distribution in intensive care unit （ICU） and to provide reference for clinical drug administration. Methods Clinical specimens from Donghua Hospital during January 2006 to December 2011 were collected and cultured using conventional microbiological method. Then these bacteria were identified and the drug resist- ance tests were performed using automatic VITEK32 microbial analyzer and disc diffusion method （K-B method）. Results A total of 1 531 strains of bacteria were separated, including Gram negative （G ） bacillus 868 strains （56.7%）, Gram positive bacteria （G^＋ ） 381 strains （24.9%）,and fungi 225 strains （14.7%）. The most popular G bacillus were Klebsiella pneumoniae（13. 3%, 204 strains） ,Acinetobacter baumannii （ 12.1 %, 185 strains）, Escherichia coli （9.7 %, 148 strains）, Pseudomonas aeruginosa strains （7.8 %, 120 strains）, and Stenotrophomonas maltophilia （3.0 %, 46 strains）, et al. The most popular G＋ bacteria were Staphylo- coccus aureus （8. 6%, 131 strains）, Hemolytic staphylococcus （3. 3%, 51 strains） and Staphylococcus epidermidis （3. 1%,47 strains）, Enterococcus faecalis （2.3 %, 35 strains） ,and Streptococcus pneumoniae （1.9 %, 29 strains）. Most of the G bacteria were resistant to the third generation cephalosporins,but they were high sensitive to imipenem. No vancomycin-resistant Staphylococcus had been found. Conclusion G bacteria is still the main infection source in ICU,but G＋ bacteria is increasing. Bacterial resistance monitoring should be performed on clinical bacteria to prevent the generation of antibiotic resistant bacteria.

关 键 词：重症监护病房 细菌分布 细菌耐药 

分 类 号：R446.5[医药卫生—诊断学]