重症监护室革兰阳性菌的分布特点与耐药性分析  

Distribution of Gram-positive bacteria and drug resistance in intensive care unit

作　　者：戴友爱[1] 张秀红[1] 周晓[1] 殷建忠[1] 

机构地区：[1]南京医科大学附属无锡人民医院,无锡214023

出　　处：《中国急救复苏与灾害医学杂志》2016年第4期377-379,共3页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的了解重症监护室革兰阳性菌的分布情况与耐药性。方法收集2012～2014年无锡市人民医院ICU住院1923例感染患者抗菌药物使用前的血液、脓液、尿、痰、脑脊液、胸水、腹水和其他分泌物标本。用全自动微生物检定仪进行细菌种类的鉴定和药物敏感试验。结果共分离出病原菌568株，革兰阴性菌占60．29％，革兰阳性菌占37．14％，真菌占2．57％。检出革兰阳性菌的标本以血和痰居多，前三位病原菌依次是人葡萄球菌（20．38％）、草绿色链球菌（15．64％）和金黄色葡萄球菌（14．69％）。31株金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌（MRSA）占48．38％。革兰阳性菌对青霉素、红霉素、克林霉素和苯唑西林敏感率分别为18．68％、24．56％、29．25％和31．84％，而对替加环素、万古霉素和利奈唑胺敏感率都为100％。结论ICU致病菌中革兰阳性菌以葡萄球菌居多，耐药形势严峻。Objective To investigate the distribution of Gram-positive bacteria and drug resistance in ICU. Methods Before anti-bacterial treatment, biological samples including the sputum, blood, urine, cerebrospinal fluid, ascitic fluid and pleural fluid were collected from 1923 patients admitted into the ICU of Wuxi PeopleJs Hospital from 2012 to 2014. Then, bacterial species and susceptibility of pathogentic microorganisims were performed by an automatic microbial analyzer. Results Totally, 568 strains of pathogens were isolated, including 60.29% of gram-negative bacteria, 37.14% of Gram-positive bacteria, and 2.57% of fungi. More Gram-positive bacteria were detected in the blood and sputum than other samples. The top three Gram-positive bacteria were Staphylococcus hominis （20.38%）, Streptococcus viridans （15.64%） and Staphylococcus aureus （14.69%）. Moreover, 48.38% of Staphylococcus aureus were methicillin-resistant staphylococcus aureus （MRSA）. The sensitive rates of Gram-positive bacteria to penicillin, erythromycin, clindamycin and oxacillin were 18.68%, 24.56%, 29.25%, and 31.84% respectively. In contrast, Gram-positive bacteria showed 100% of sensitive rate to tigecycline, vancomycin and linezolid. Conclusion Most of Gram positive infections in ICU are caused by cocci. The present situation of bacterial resistance to antibiotics is serious.

关 键 词：重症监护室 革兰阳性菌 药物敏感 抗菌药物 

分 类 号：R969.3[医药卫生—药理学]