NICU感染病原菌分布及耐药性分析  

Analysis of pathogen distribution and resistance in Neurological intensive care unit

作　　者：呼建民 王述莲[2] 刘献增[3] 

机构地区：[1]武警北京市总队第三医院神经功能科,北京100141 [2]武警北京市总队第三医院检验科,北京100141 [3]北京大学人民医院神经功能科,北京100044

出　　处：《中华医院感染学杂志》2014年第5期1084-1086,共3页Chinese Journal of Nosocomiology

基　　金：北京大学人民医院研究与发展基金资助项目(RDC2010-06)

摘　　要：目的研究神经重症监护病房(NICU)发生感染的菌群分布特点及耐药性,为临床用药提供依据。方法回顾性分析2008年1月-2012年12月NICU住院患者送检标本进行细菌培养、鉴定及药敏试验;标本采集严格按《临床检验操作规程》无菌操作;采用法国生物梅里埃公司VITEK-32全自动微生物鉴定仪及该公司配套软件进行菌株鉴定及药敏试验分析,采用WHONET5.4数据处理软件进行统计分析。结果 119例患者共分离病原菌268株,其中呼吸道236株占88.1%,脑脊液12株占4.5%,血液8株占3.4%,其他12株占4.5%;268株病原菌包括革兰阴性杆菌176株占65.7%,其中以肺炎克雷伯菌47株、鲍氏不动杆菌41株、大肠埃希菌36株、铜绿假单胞菌29株为多见,均呈现不同程度的多药耐药性,对亚胺培南、美罗培南较为敏感;革兰阳性球菌82株占30.6%,以金黄色葡萄球菌37株、肠球菌属16株、肺炎链球菌11株为多见,均呈现不同程度的多药耐药性,其金黄色葡萄球菌对青霉素G、庆大霉素、头孢吡肟耐药率均>80.0%,金黄色葡萄球菌、肠球菌属、肺炎链球菌对抗菌药物以替考拉宁、万古霉素较为敏感;真菌10株,占3.7%,以白色假丝酵母菌为主。结论遵循药敏试验合理使用抗菌药物,一方面可保证患者临床治疗的有效性,另一方面也减少临床耐药菌株的产生。OBJECTIVE To study the the pathogen distribution characteristics and infection resistance in neurological intensive care unit （NICU） and provide a basic information for the use of clinical drugs. METHODS Retrospective analysis was conducted from January, 2008 to December, 2012 in NICU of our hospital for the bacterial auture , identification and susceptibility testing. RESULTS 268 pathogens form 119 patients were isolated, 236 strains from including respiratory tract, accounting for 88. 1%, 12 from brain fluid, accounting for 4. 5%, 8 from blood, accounting for 3.4%, 12 from Others, accountiing for 4. 5%. Among 268 pathogens, gram-negative （G-） bacilli were 176 strains （65. 6 %）, including 47 ofK lebsiella pneumoniae , 41 of Acinetobacter acinetobacter , 36 of Escherichia coli, 29 of Pseudomonas aeruginosa. There were 82 of Gram-positive cocci （G ＋ ） （30.6%）, including 37 of Staphylococcus aureus, 16 of Enterococcus, 11 of Streptococcus pneumoniae . There were 10 fungi （3. 7 %）, including 70f Candida albicans; Klebsiella pneumoniae , Acinetobacter baumannii , Escherichia coli, Pseudomonas aeruginosa showed different multi-drug resistant rate antimicrobial agents of imipenern , meropenem were more sensitive; Staphylococcus aureus , Enterococcus, Streptococcus pneumoniae （G＋） showed varied rates of multi-drug resistance, especially resistance rates to penicillin G, gentamicin, cefepime were above 80. 0 % . Staphylococcus aureus , Enterococcus, Streptococcus pneumoniae to teicoplanin , vancomycin were sensitive. CONCLUSION Peasonable use of antibiotics according to the result of susceptibility testing, will ensure the effectiveness of clinical treatment, as well as reduce the production of clinical drug-resistant strains.

关 键 词：神经重症监护病房 感染 病原菌 分布 药敏试验 耐药性 

分 类 号：R378[医药卫生—病原生物学]