重症监护病房与普通住院科室医院感染中阴沟肠杆菌的耐药性对比  

Drug resistance of Enterobacter cloacae strains causing nosocomial infections in intensive care unit and common wards

作　　者：汪艳[1] 陈乐[2] 周易[3] 

机构地区：[1]黄冈市中心医院院感科,湖北黄冈438000 [2]黄冈市中心医院儿科,湖北黄冈438000 [3]黄冈市中心医院医务科,湖北黄冈438000

出　　处：《中华医院感染学杂志》2017年第2期272-275,共4页Chinese Journal of Nosocomiology

基　　金：湖北省科技厅自然基金项目(EK2016D150054001099)

摘　　要：目的对比重症监护病房(ICU)与普通住院科室医院感染中的阴沟肠杆菌的耐药性,为医院感染预防控制工作提供依据。方法选取2013年1月-2016年8月在ICU住院患者(110例)和普通病房住院治疗患者(562例)的516份送检标本作为研究资料,对其阴沟肠杆菌感染情况及耐药性进行观察和分析。结果在57例患者的病原学标本中检出阴沟肠杆菌,ICU与普通病房患者阴沟杆菌感染率的差异无统计学意义,共检出阴沟肠杆菌65株,菌株主要来源于痰液、切口分泌物和伤口分泌物,构成比分别占64.6%、7.7%和6.2%;ICU分离阴沟肠杆菌对头孢曲松、氯霉素、头孢唑林、头孢噻肟、头孢呋辛的耐药率较高,分别为100.0%、100.0%、75.0%、75.0%和75.0%,普通病房分离的阴沟肠杆菌对头孢唑林、氨苄西林的耐药率较高,分别为94.3%和92.5%,所有菌株对氧氟沙星、亚胺培南、美罗培南、阿米卡星、哌拉西林/舒巴坦较敏感;ICU分离菌株对头孢曲松、头孢噻肟、庆大霉素、环丙沙星、呋喃妥因、哌拉西林、哌拉西林/舒巴坦、头孢哌酮、头孢哌酮/舒巴坦、头孢吡肟、美罗培南、妥布霉素、奈替米星、氯霉素的耐药率均显著高于普通病房,普通病房分离的菌株对头孢唑林、氨苄西林的耐药率均高于ICU,以上差异均有统计学意义(P<0.05)。结论临床分离的阴沟肠杆菌的耐药性较强,且ICU分离菌株的耐药性要高于普通病房分离株,临床医师应给予高度重视并选用敏感药物进行抗感染治疗。OBJECTIVE To compare the drug resistance of Enterobacer cloacae strains causing nosocomial infections between intensive care unit （ICU） and common wards so as to provide guidance for prevention and control of the nosocomial infections. METHODS A total of 516 submitted specimens were obtained from 110 patients who were hospitalized in ICU and 562 patients who were hospitalized in common wards from Jan 2013 to Aug 2016. The incidence of E. cloacae infection and drug resistance were observed. RESULTS The E. cloacae strains were detected in etiological specimens of 57 patients, and there was no significant difference in the incidence of E. cloacae infection between the ICU patients and the common ward patients. Of totally 65 strains of E. cloacae isolated, 64.6% were isolated from sputum specimens, 7. 7% were isolated from incision secretions, and 6. 2% were isolated from wound secretions. The drug resistance rates of the E. cloacae strains isolated from the ICU to ceftriaxone, chlor-amphenicol, cefazolin, cefotaxime, and cefuroxime were 100.0%, 100.0%, 75.0%, 75.0%, and 75.0% ,respectively; the drug resistance rates of the E. cloacae strains isolated from the common wards to cefazolin and ampicillin were 94.3% and 92.5%, respectively. All of the strains were highly susceptible to levofloxacin, imipenem, meropenem, amikacin, and piperacillin-sulbactam. The drug resistance rates of the E. cloacae strains isolated from the ICU to ceftriaxone, cefotaxime, gentamicin, ciprofloxacin, nitrofurantoin, piperacillin, piperacillin-sulbac-tam, cefoperazone, cefoperazone-sulbactam, cefepime, meropenem, tobramycin, netilmicin, and chloramphenicol were significantly higher than those of the E. cloacae strains isolated from the common wards, the drug resistance rates of the E. cloacae strains isolated from the common wards to cefazolin and ampicillin were higher than those of the E. cloacae strains isolated from the ICU（P〈0.05）. CONCLUSION The clinical E. cloacae isolates are highly drug-resistant, and the drug resistance

关 键 词：重症监护病房 普通病房 阴沟肠杆菌 医院感染 耐药性 

分 类 号：R378.2[医药卫生—病原生物学]