重症监护病房(ICU)血流感染病原体分布及耐药性分析  

Surveillance of distribution and antimicrobial resistance among bloodstream infection pathogen from intensive care units

作　　者：叶志军[1] 吴峰 雷蕾[3] YE Zhi-jun;WU Feng;LEI Lei(Department of Hospital Infection Management;Department of Orthopedics and Trauma;Clinical Microbiology Laboratory,Foshan Hospital of TCM,Foshan,Guangdong 528000)

机构地区：[1]广东省佛山市中医院医院感染管理科,广东佛山528000 [2]广东省佛山市中医院骨科,广东佛山528000 [3]广东省佛山市中医院检验科,广东佛山528000

出　　处：《赣南医学院学报》2018年第6期586-589,共4页JOURNAL OF GANNAN MEDICAL UNIVERSITY

摘　　要：目的:了解重症监护病房(ICU)中血流感染病原菌的分布特点及其耐药性,以指导临床合理用药。方法:收集ICU 2015年1月~2017年12月血流感染患者微生物学和药物敏感试验资料进行回顾性分析,采用Bac T/Alert 3D全自动血培养仪对血液标本进行培养,采用VITEK-2全自动细菌鉴定系统对阳性标本进行菌株鉴定,药敏测定采用纸片扩散法。结果:血培养共分离出118株病原菌,其中革兰阳性菌(G^+)52株占44.07%,革兰阴性菌(G^-)54株占45.76%,真菌9株占7.63%,其他细菌3株占2.54%。引起血流感染的主要病原菌依次为凝固酶阴性葡萄球菌(CNS)(35株)、大肠埃希菌和肺炎克雷伯菌(各14株)、鲍曼不动杆菌(11株)、真菌(9株)、金黄色葡萄球菌(7株)和肠球菌属(5株)、链球菌属和铜绿假单胞菌(各4株)、阴沟肠杆菌(3株)和沙门菌属(2株),提示G^+菌中以凝固酶阴性葡萄球菌为主,G^-菌中以大肠埃希菌、肺炎克雷菌和鲍曼不动杆菌为主。药敏结果显示,7株金黄色葡萄球菌中对甲氧西林耐药占57.14%,35株CNS中对甲氧西林耐药占80.00%,未检出耐万古霉素和利柰唑胺的G^+菌。肠杆菌对头孢哌酮/舒巴坦、阿米卡星、庆大霉素、美罗培南及亚胺培南的敏感率均>90%;鲍曼不动杆菌多重耐药的情况较严重,对多数受试药物耐药率在60%以上。结论:近3年ICU内血流感染患者病原菌G^+菌与G^-菌分布基本持平,多药耐药菌检出率较高,定期开展医疗机构内的血流感染监测工作,对于指导抗菌药物合理应用及医院感染管理十分重要。Objective： To investigate the distribution and antimicrobial resistance of clinical isolates derived from intensive care unit（ ICU） patients in Foshan Hospital of TCM,in order to guide rational drug use clinically. Methods： Microbiological and drug sensitive test data of patients with bloodstream infections from ICU of Foshan Hospital of TCM were collected and analyzed retrospectively from January,2015 to December,2017. Culture of blood specimen was carried out by Bac T/Alert 3D automatic blood culture apparatus. And the strains of bacteria and positive samples were identified by VITEK-2 automatic bacterial identification system. Antimicrobial susceptibility testing was carried out according to paper diffusion method. Results： 118 of pathogenic bacteria were isolated from the blood culture. And there were 52 strains gram-negative organisms,accounting for 44. 07%; while there were 54 strains gram-positive organisms accounting for45. 76% respectively. There were 9 strains of fungi accounting for 7. 63%. There were 3 strains of other bacteria accounting for 2. 54%. The main pathogenic bacteria causing blood flow infection were Coagulase-negative Staphylococcus（ 35 strains）,Escherichia coli and Klebsiella pneumoniae（ 14 strains）,Acinetobacter baumannii（ 11 strains）,fungi（ 9 strains）,Staphylococcus aureus（ 7 strains） and Enterococcus（ 5 strains）,Pseudomonas aeruginosa and Streptococcus（ 4 strains）,Enterobacter cloacae（ 3 strains） and Salmonella（ 2 strains）. It showed Coagulase-negative Staphylococcus were the majority in gram-positive organisms while Escherichia coli,Klebsiella pneumonia and Acinetobacter baumannii in gram-negative organisms. Antimicrobial susceptibility testing showed that 57. 14% of Staphylococcus aureus strains were Methicillin resistance,while 80. 00% of CNS strains were Methicillin resistance. No gram-positive organisms was resistant to vancomycin and linezolid. The sensitivity rates of Enterobacteriaceae to cefoperazone sulbactam,Amikacin,gentamycin,

关 键 词：血流感染 细菌培养 细菌耐药 重症监护病房 

分 类 号：R446[医药卫生—诊断学]