2019-2021年某三级医院重症监护病房主要病原菌分布及其耐药性分析  

Distribution and resistance of main pathogen isolated from an intensive care unit of a tertiary hospital in 2019-2021

作　　者：王丽恒[1] 王贵霞[1] 刘婧 何明[2] 谢宁[3,4,5] WANG Li-heng;WANG Gui-xia;LIU Jing;HE Ming;XIE Ning(Department of Infection,North Sichuan Medical College,Nanchong 637000,Sichuan,China;Department of Gastrointestinal Surgery,Affiliated Hospital of North Sichuan Medical College,North Sichuan Medical College,Nanchong 637000,Sichuan,China;Department of Laboratory Medicine,North Sichuan Medical College,North Sichuan Medical College,Nanchong 637000,Sichuan,China;Department of Clinical Laboratory,Affiliated Hospital of North Sichuan Medical College,North Sichuan Medical College,Nanchong 637000,Sichuan,China;Center for Translational Medicine,North Sichuan Medical College,Nanchong 637000,Sichuan,China)

机构地区：[1]川北医学院附属医院感染科,四川南充637000 [2]川北医学院附属医院胃肠外一科,四川南充637000 [3]川北医学院医学检验系,四川南充637000 [4]川北医学院附属医院检验科,四川南充637000 [5]川北医学院转化医学研究中心,四川南充637000

出　　处：《川北医学院学报》2022年第12期1604-1608,共5页Journal of North Sichuan Medical College

基　　金：川北医学院附属医院科研项目(2022JC024)。

摘　　要：目的:分析重症监护病房(ICU)病原菌分布及耐药情况,为临床合理用药提供依据。方法:回顾性分析某三甲医院综合ICU所取1487个标本,2363株病原菌分布及药敏试验结果,用SigmaStat.3.1软件进行数据统计分析。结果:2363株病原菌主要来源于呼吸道标本(68.0%);G+菌、G-菌和真菌占比分别为20.8%、67.4%和11.8%;三类病原菌的年度构成比之间差异有统计学意义(P<0.05),其中G+菌占比逐年下降,真菌占比逐年增加。G-菌检出率依次为肺炎克雷伯菌(21.7%)、鲍曼不动杆菌(12.1%)、铜绿假单胞菌(7.3%)、大肠埃希菌(7.2%)和嗜麦芽窄食单胞菌(4.2%);G+菌和真菌以金黄色葡萄球菌和白念珠菌检出率最高(分别为6.0%和4.4%)。药敏试验结果显示,4种G+菌(不包括纹带棒状杆菌)对所试抗菌药的平均耐药率为31.6%~55.5%。嗜麦芽窄食单胞菌对左氧沙星、复方新诺明和米诺环素的耐药率较低(0~2.1%),其它4种G-菌对所试抗菌药的平均耐药率为30.4%~75.8%,其中鲍曼不动杆菌对11种抗菌药的耐药率高达67.5%~100%(仅替加环素耐药率为0.4%)。结论:本院ICU以呼吸道感染为主,病原菌以G-菌居多,以肺炎克雷伯菌最多见。真菌感染不容忽视。细菌的耐药性严重,规范抗菌药物使用和加强细菌耐药性实时监测具有重要意义。Objective:To analyze the distribution and resistance of pathogens detected in intensive care unit(ICU),and to provide a rational for the usage of antibacterial agents in clinic.Methods:To retrospectively analyze the distribution and drug sensitivity test results of 2,363 strains from 1,487 samples taken from ICU of a tertiary hospital.The drug sensitivity test of was carried out by automatic instrument.The data were statistically analyzed by SigmaStat.3.1 software.Results:2,363 strains were mainly isolated from m respiratory tract specimens(68%).The total ratio of Gram negative(G-),Grampositive(G+)bacteria and fungus were 67.4%,20.8%and 17.8%,respectively,and there were annual differences for the ratio(P<0.05).The proportion of G+bacteria was decreasing year by year,and that of fungi increased.The most common G-bacteria were Klebsiella pneumoniae(21.7%),Acinetobacter baumannii(12.1%),Pseudomonas aeruginosa(7.3%),Escherichia coli(7.2%)and Stenotrophomonas maltophilia(4.2%).Staphylococus aureus(6.0%)and Moniliaalbicans(4.4%)were the main G+bacteria and fungus,respectively.The results of drug sensitivity test showed that the average drug-resistance rates of G+bacteria(except Corynebacterium striatum)were 31.6%~55.5%,the resistance rate of Stenotrophomonas maltophilia to levofloxacin,cotrimoxazole and minocycline was low(0~2.1%),and the average resistance rate of the other four G-bacteria to the tested antibacterial agents was 30.4%~75.8%,among which the resistance rate of Acinetobacter baumannii to 11 kinds of drugs were higher(67.5%~100%),but the resistance rate of tigecycline was 0.4%.Conclusion:Respiratory tract Infection was the commonest in ICU,and G-bacteria are the commonest pathogens.Klebsiella pneumoniae is the commonest pathogen.Fungal infection should be noticeable.The drug resistance in ICU is serious.To standardize the use of antibacterial agents and to monitor real-time changes of bacterial drug-resistance are very important.

关 键 词：重症监护病房 病原菌 耐药性 抗菌药 

分 类 号：R446.5[医药卫生—诊断学]