2011—2015年ICU患者感染病原菌分布及耐药性分析  

Distribution and Drug Resistance of Pathogens Causing Infections in the ICU Patients from 2011 to 2015

作　　者：葛丽卫[1] 杨伟平[1] 罗媛烨[1] 黄支密[1] 

机构地区：[1]中国人民解放军第九八医院检验科,湖州313000

出　　处：《国外医药（抗生素分册）》2017年第2期67-71,I0002,共6页World Notes on Antibiotics

摘　　要：目的了解ICU患者感染病原菌分布规律及其耐药性,为临床合理选用抗菌药物提供参考依据。方法收集2011—2015年ICU患者细菌学标本送检,采用Micro Scan WalkAway-96 plus全自动微生物分析系统进行细菌鉴定及药敏试验,采用WHONET 5.6和SPSS 19.0软件统计分离出的非重复性感染细菌种类并进行耐药性分析。结果5年间,ICU共分离出各种病原菌1713株,其中1270株来自痰液,占74.14%。革兰阴性菌共计1200株(70.05%),居前4位的依次是鲍曼不动杆菌293株(17.10%)、肺炎克雷伯菌263株(15.35%)、铜绿假单胞菌216株(12.61%)和黏质沙雷菌116株(6.77%),他们对亚胺培南耐药率分别为84.19%、28.14%、51.39%和6.90%,对美罗培南耐药率分别为83.13%、16.42%、35.91%和13.04%,对第三代头孢菌素类、头孢吡肟和氨曲南耐药率在30.17%~90.74%之间,对3种氟喹诺酮类耐药率在27.27%~100.0%之间。革兰阳性菌共计375株(21.89%),居前3位的依次是凝固酶阴性葡萄球菌(CNS)193株(11.27%)、金黄色葡萄球菌(SA)119株(6.95%)、肠球菌属35株(2.04%);SA和CNS对苯唑西林耐药率分别为47.90%和93.78%,差别非常明显(P<0.001),对青霉素G耐药率分别为94.83%和96.30%(P>0.05),二者对万古霉素均敏感;肠球菌属对万古霉素耐药率为5.71%。真菌138株(8.06%),其中假丝酵母125株(7.30%)。结论ICU患者感染绝大多数发生在下呼吸道,病原菌以革兰阴性菌为主,多重耐药情况非常严重,临床应根据药敏结果合理选用抗菌药物,以延缓耐药菌产生。Objective To investigate the distribution and drug resistance of the pathogens causing infections in the patients of intensive care unit（ICU） so as to provide guidance for reasonable clinical use of antimicrobials. Methods Collect the bacteriological specimens in ICU inpatients for bacterial identification and antimicrobial susceptibility testing by using MicroScan WalkAway-96 plus automated microbial analysis systems. To perform a drug resistance analysis by using WHONET 5.6 and SPSS 19.0 software with separated non-recurring infection bacterial species. Results A total of 1713 pathogens were isolated in the ICU patients during 2011-2015, among them 1270 strains from sputum（74.14%）. Gram-negative bacteria total 1200 strains（70.05%）, the isolating rate ofA. baumanii, K. pneumonia, P. aeruginosa and S. marcescens accounted 17.10%, 15.35%, 12.61%, 6.77% and ranked in top 4 respectively（888 strains totally, 51.83%）, the resistance rate to imipenem were 84.19%, 28.14%, 51.39% and 6.90% respectively, to meropenem were 83.13%, 16.42%, 35.91% and 13.04% respectively, to third- generation cephalosporin, cefepime and aztreonam of between 30.17% and 90.74%, and to 3 kinds of fluroquinolones of between 27.27% and 100.0%. Gram-positive bacteria total 375 strains（21.89%）, the isolating rate of coagulase- negative Staphylococci（CNS）, S. aureus and Enterococcus accounted 11.27%, 6.95%, 2.04% and ranked in top 3 respectively（347 strains totally, 20.26%）, The resistance rates of S. aureus and CNS to oxacillin were 47.90% and 93.78%（P〈0.001）, to penicillin G were 94.83% and 96.30%（P〉0.05）, no Staphylococcus strains was resistance to vancomvcin. The resistance rates of Enterococcus to vancomvcin was 5.7i%. Fungi total 138 strains（8.06%）.Conclusion The bacterial infection in the ICU mainly distributes in the lower respiratory tract, and the gram- negative bacteria are the predominant among the pathogens, and multiple drug resistance is very serious. In order to delayed the production of dr

关 键 词：重症监护病房 医院感染 病原菌 分布 耐药性 

分 类 号：R446.5[医药卫生—诊断学]