重症监护病房病原菌分布及耐药性趋势分析  

Study on the tendency of pathogenic bacteria distribution and drug resistance in intensive care unit

作　　者：宋岐峰 李国福[1] 臧彬[1] Song Qifeng;Li Guofu;Zang Bin(Department of Critical Care Medicine,Shengjing Hospital Affiliated to China Medical University,Shenyang 110000.Liaoning,China)

机构地区：[1]中国医科大学附属盛京医院重症医学科,辽宁沈阳110000

出　　处：《中国中西医结合急救杂志》2022年第1期17-21,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：辽宁省临床重点专科(辽卫办发[2015]111号)。

摘　　要：目的 分析重症监护病房(ICU)病原菌分布及药敏情况并总结趋势,以期为未来抗感染治疗提供参考及依据.方法 回顾性分析2018年1月至2020年12月中国医科大学附属盛京医院滑翔院区ICU临床所取363例病原菌标本和菌种鉴定结果,抗菌药物的药敏试验采用自动化仪器法和纸片扩散法进行;用WHONET 5.6软件进行数据分析.结果 本院ICU病原菌主要来源于呼吸道标本(172例,占47.4%);以革兰阴性(G-)菌为主(257株,占70.8%),且逐年增多,其中以鲍曼不动杆菌最多(66株,占18.2%);革兰阳性(G+)菌93株(25.6%),真菌13株(3.6%).多重耐药菌共109株(30.0%),数量及耐药性均逐年增加,其中最具有代表性的就是鲍曼不动杆菌,共48株(44.0%).药敏试验结果显示,病原菌耐药性总体上呈上升趋势.其中鲍曼不动杆菌最突出,除替加环素、米诺环素及头孢哌酮/舒巴坦外,大多数抗菌药物耐药率均90%以上.结论 ICU中病原菌耐药性日趋增强.治疗上应采用以替加环素、多黏菌素及部分氨基糖胺类药物为主导的联合用药.临床上应加强无菌观念,减少非必要的有创操作.Objective To analyze the distribution and drug sensitivity of pathogens in intensive care unit(ICU)and summarize the trend in order to provide reference and basis for anti-infection treatment in the future.Methods The identification results of 363 pathogen samples and strains taken from ICU of Huaxiang branch of Shengjing Hospital Affiliated to China Medical University from January 2018 to December 2020 were analyzed retrospectively.The drug sensitivity test of antibiotics was carried out by automatic instrument method and disk diffusion method.The data were analyzed hy WHONET 5.6 software.Results The pathogens in ICU in our hospital mainly came from respiratory tract specimens(172 cases,accounting for 47.4%);Gram negative(G^(-))bacteria were the main bacteria(257 strains,70.8%)and increased year hy year,and among this kind of bacteria,the number of Acinetobacter baumannii strain was the highest(66 strains.18.2%);there were 93 strains of gram positive(G)bacteria(25.6%)and 13 strains of fungi(3.6%).In the ICU,there were 109 strains(30.0%)of nmltidrug-resistant bacteria,and the number and dnig resistance has been increasing year by year.Among them,the most representative is Acinetobacter baumannii.with a total number of 48 strains(44.0%).The results of drug sensitivity test showed that the drug resistance of pathogens has presented an upward trend on the whole,and among the resistant bacteria,Acinetobacter baumannii is the most prominent,and except tegacyclin,minocycline and sulbactam,the dnig resistance rates of most antibiotics are all more than 90%.Conclusions The drug resistance of pathogens in ICU has been increasing clay by day.The combination of tegacyclin,polymyxin and few aminoglycosamines should be mainly used in treatment.Clinically,it is necessary to strengthen the concept of sterility and reduce unnecessary invasive operations.

关 键 词：重症监护病房 病原菌 革兰阴性菌 革兰阳性菌 多重耐药菌 鲍曼不动杆菌 

分 类 号：R44[医药卫生—诊断学]