我院中心ICU感染病原菌的分布及耐药性分析  

Distribution and antimicrobial resistance of pathogens associated with infection in general intensive care unit in a hospital

作　　者：李芳[1] 李雅丽 雷金娥[1] 陈葳[1] 王军阳[2] 曾晓艳[1] LI Fang;LI Yali;LEI Jin′e;CHEN Wei;WANG Junyang;ZENG Xiaoyan(Department of Clinical Laboratory,the First Affiliated Hospital,Xi′an Jiaotong University,Xi′an 710061,China;Department of Immunology and Pathogenic Biology,Health Science Center,Xi′an Jiaotong University,Xi′an 710061,China)

机构地区：[1]西安交通大学第一附属医院检验科,西安710061 [2]西安交通大学医学部免疫学与病原生物学系,西安710061

出　　处：《西北药学杂志》2019年第1期116-121,共6页Northwest Pharmaceutical Journal

基　　金：国家自然科学基金项目(编号:81201326);陕西省重点研发计划项目(编号:2017SF-170)

摘　　要：目的探讨西安交通大学第一附属医院中心ICU病房患者感染病原菌类型、分布及耐药情况,为指导医院感染病原菌耐药性监测和临床合理应用抗菌药物提供依据。方法对该院2013年1月～2016年12月中心ICU住院患者送检标本中的病原菌进行培养、分离及鉴定,采用纸片扩散法、E-test法或全自动细菌分析仪测定细菌对不同抗菌药物的敏感性。结果共分离出3 526株病原菌,包括革兰阴性杆菌2 446株(69.4%)、革兰阳性球菌659株(18.7%)和真菌421株(11.9%)。革兰阴性杆菌主要为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌和嗜麦芽窄食单胞菌。革兰阳性球菌主要为屎肠球菌、金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌和溶血葡萄球菌。耐碳青霉烯类(亚胺培南)鲍曼不动杆菌和铜绿假单胞菌的检出率分别为92.9%和56.8%。产超广谱β-内酰胺酶的大肠埃希菌和肺炎克雷伯菌分别占76.1%和63.6%。多重耐药葡萄球菌主要为耐甲氧西林金黄色葡萄球菌(65.9%)和耐甲氧西林凝固酶阴性葡萄球菌(>90%),其对万古霉素、替加环素和利奈唑胺的敏感率为100%。肠球菌属的整体耐药性十分严重,屎肠球菌比粪肠球菌的耐药率高。真菌主要为白色假丝酵母菌,对抗真菌药物的敏感率为90%。结论中心ICU患者医院感染的致病菌主要为革兰阴性杆菌,且主要为多重耐药的非发酵革兰阴性杆菌。ICU应加强对病原菌的耐药性监测,并根据药敏结果指导临床合理应用抗生素。Objective To investigate the distribution and antimicrobial resistance of pathogenic bacteria associated with the patients in general intensive care unit(ICU)in the First Affiliated Hospital of Xi′an Jiaotong University so as to provide the information for reasonable use of antimicrobial agents in clinic and guide the antimicrobial resistance monitoring.Methods The samples which were collected from patients in the ICU from Jan.2013 to Dec.2016 were used for bacterial culture and isolation.The isolates were identified by using automatic bacteria analyzer BioMerieux,France.The antimicrobial susceptibility of bacteria was tested by using Kirby-Bauer test,E-test or automatic bacteria analyzer.Results A total of 3 526 strains of pathogenic bacteria were isolated,including 2 446 strains(69.4%)of Gram-negative bacilli,659 strains(18.7%)of Gram-positive cocci and 421 strains(11.9%)of fungi.Acinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumonia,Escherichia coli,Stenotrophomonas maltophilia ranked the top 5 species of the Gram-negative bacilli.Enterococcus faecium,Staphylococcus aureus,Staphylococcus epidermis and Staphylococcus haemolyticus were the main Gram-positive cocci.The detection rates of carbapenem-resistant(imipenan)Acinetobacter baumannii and pseudomonas aeruginosa were 92.9%and 56.8%.The extended-spectrum-β-lactamase-producing Escherichia coli and Klebsiella pneumoniae accounted for 76.1%and 63.6%respectively.Staphylococcus were multidrug-resistant,which were mainly methicillin-resistant Staphylococcus aureu(65.9%)and methicillin-resistant coagulase negative Staphylococcus(>90%),with antimicrobial sensitive rates of 100%to vancomycin,tigecycline and linezolid.The antimicrobial resistance of Enterococcus was pretty serious,in which the resistance rate of Enterococcus faecium was higher than that of Enterococcus faecalis.Candida albicans was the main fungi detected,with an sensitive rate over 90%to anti-fungal agents.Conclusion Most of the pathogenic bacteria isolated from ICU are Gram-negative b

关 键 词：ICU 病原菌 细菌耐药性 

分 类 号：R969.3[医药卫生—药理学]