重症监护室患者致病菌监测及耐药性分析  

Surveillance and Drug Resistance of Pathogens in ICU Patients

作　　者：夏静鸿[1] 王爱萍[1] 刘美清[1] 朱光发[1] 

机构地区：[1]首都医科大学附属北京安贞医院,北京100029

出　　处：《中国呼吸与危重监护杂志》2016年第5期446-452,共7页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的了解重症监护室患者致病菌感染和耐药情况,为预防重症感染和经验用药提供参考依据。方法回顾性分析2013年1月至2014年12月首都医科大学附属北京安贞医院重症监护室的住院患者,细菌及真菌培养阳性病例,分析其菌群分布及致病菌耐药性。结果 2年间重症监护室患者共收集临床非重复分离株2 088株,其中革兰阴性菌1403株(67.2%),革兰阳性菌496株(23.8%),真菌189株(9.0%)。痰液等呼吸道标本1324株(63.42%);血液标本487株(23.33%);其他标本277株(13.27%)。分离出鲍曼不动杆菌(17.2%)、肺炎克雷伯菌(14.8%)、铜绿假单胞菌(9.9%)、白念珠菌(6.3%)、大肠埃希菌(5.6%)、阴沟肠杆菌(5.4%)、表皮葡萄球菌(5.0%)及金黄色葡萄球菌(4.7%)。碳青霉烯类耐药肠杆菌科细菌(CRE)15株,占2.3%,其中肺炎克雷伯菌5株,阴沟肠杆菌4株。大肠杆菌中多耐药菌株占86.4%,其中MDR占85.5%,XDR占0.9%;鲍曼不动杆菌中多耐药菌株占75.2%,其中XDR占72.1%,MDR占3.1%;铜绿假单胞菌中多耐药菌株占10.6%。MRSA及MRCNS检出率分别为49.0%和95.5%,耐万古霉素肠球菌(VRE)4株,均为粪肠球菌。真菌中白念珠菌131株(69.3%),光滑球念珠菌23株(12.2%)。白念珠菌对两性霉素及5氟胞嘧啶均敏感,对其他抗菌素耐药率小于1%;光滑球念珠菌耐药率较白念珠菌及近平滑念珠菌高,但仍全部小于15%。结论重症监护室患者致病菌以革兰阴性菌为主,排名前8位的致病菌分别是鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌、白念珠菌、大肠埃希菌、阴沟肠杆菌、表皮葡萄球菌及金黄色葡萄球菌。痰液及血液标本多见。CRE占2.3%。大肠杆菌中多耐药菌株最多,但主要以MDR为主;其次为鲍曼不动杆菌,以XDR为主;铜绿假单胞菌中耐药菌株最少。真菌中白念珠菌最多,耐药率仍较低。Objective To investigate the pathogen distribution and drug resistance in ICU patients, provide reference for prevention of severe infection and empirical antibacterial treatment. Methods The patients admitted in ICU between January 2013 and December 2014 were retrospectively analyzed. The pathogenic data were collected including bacterial and fungal culture results, the flora distribution and drug resistance of pathogenic bacteria. Results A total of 2088 non-repeated strains were isolated, including 1403 （67.2%） strains of Gram-positive bacteria,496 （23.8%） strains of Gram-negative bacteria,and 189 （9.0%） strains of fungus. There were 1324 （63.42%） strains isolated from sputum or other respiratory specimens ,487 （23.33%） strains from blood specimens ,277 （13.27%） strains from other specimens. The bacteria included Acinetobacter baumannii （ 17. 2% ）, KlebsieUa pneumoniae （ 14. 8% ）, Pseudomonas aeruginosa （9.9%）, C. albicans （6.3%）, E. coli （5.6%）, E. cloacae （5.4%）, Epidermis staphylococcus （5.0%） and Staphylococcus aureus （4. 7% ）. There were 15 strains of penicillium carbon resistant enterobacteriaceae bacteria （CRE） accounting for 2. 3%, including 5 strains of Pneumonia klebsiella, 4 strains of E. cloacae. In 117 strains of E. coli, drug-resistant strains accounted for 86.4% including 85.5% of multiple drug-resistant strains （MDR） and 0. 9% of extremely-drug resistant （XDR） strains. In 359 strains of Acinetobacter baumannii, drug-resistant strains accounted for 75.2% including72. 1% of XDR strains and 3. 1% of MDR strains. MDR strains accounted for 10. 6% in Pseudomonas aeruginosa. Detection rate of methicillin resistant Staphylococcus aureus （MRSA） and methicillin resistant coagulase-negative Staphylococci （MRCNS） was 49. 0% and 95.5% , respectively. There were 4 strains of vancomycin resistant Enterococcusfaecalis. There were 131 （69. 3% ） strains of C. albicans,23 （ 12. 2% ） strains of smooth candida. C. albicans was sensi

关 键 词：重症监护室 医院感染 细菌 真菌 抗菌药物敏感性试验 耐药性 

分 类 号：R459.7[医药卫生—急诊医学]