ICU与非ICU血培养病原菌组成及耐药特点  

Characteristics of composition and antimicrobial resistance of pathogens in blood culture between ICU and non-ICU

作　　者：陶晓燕 闵昌航 于婷 王海晨[1] 李军[1] 胡咏梅[1] 邹明祥[1] Tao Xiao-yan;Min Chang-hang;Yu Ting;Wang Hai-chen;Li Jun;Hu Yong-mei;Zou Ming-xiang(Department of Laboratory Medicine,Xiangya Hospital,Central South University,Changsha 410008;Department of Laboratory Medicine,Sichuan Provincial People's Hospital,University of Electronic Science and Technology of China,Chengdu 610072)

机构地区：[1]中南大学湘雅医院检验科,长沙410008 [2]电子科技大学附属医院,四川省人民医院临床医学检验中心,成都610072

出　　处：《中国抗生素杂志》2022年第11期1207-1215,共9页Chinese Journal of Antibiotics

基　　金：国家自然科学基金青年科学基金资助项目(No.81702068)。

摘　　要：目的探讨重症监护病房(ICU)与非ICU住院患者血培养病原菌组成及耐药特点,为临床合理使用抗菌药物提供实验依据。方法对中南大学湘雅医院2015年1月—2019年12月ICU与非ICU血培养检出的病原菌的组成及耐药性进行分析,并对6种关键多重耐药菌(MDRO)的检出情况进行比较。结果共分离非重复病原菌3301株。其中,革兰阴性菌2066株,占62.59%;革兰阳性菌990株,占29.99%;真菌245株,占7.42%。ICU共分离病原菌734株,鲍曼不动杆菌最多,占19.75%;非ICU分离病原菌2567株,大肠埃希菌最多,占22.59%。在监测的6种主要病原菌中,MDRO占33.46%(631/1886)。其中,鲍曼不动杆菌中CRAB最高,达94.42%,大肠埃希菌中CREC最低,为5.02%。ICU 6种病原菌中MDRO占61.88%(276/446),高于非ICU的24.65%(355/1440)(χ^(2)=212.015,P=0)。ICU与非ICU分离的大肠埃希菌对除头孢唑林和氨曲南外的其他常用抗菌药物的耐药率差异无统计学意义(P>0.05);ICU分离的肺炎克雷伯菌和鲍曼不动杆菌对除复方磺胺甲恶唑外的其他常用抗菌药物的耐药率高于非ICU(P<0.05);铜绿假单胞菌对除阿米卡星外的其他抗菌药物的耐药率高于非ICU(P<0.05);金黄色葡萄球菌、凝固酶阴性葡萄球菌对多种抗菌药物的耐药率高于非ICU,差异有统计学意义(P<0.05)。结论中南大学湘雅医院血流感染病原菌以革兰阴性菌为主,且耐药十分严重。ICU血培养分离菌株MDRO检出率高,对多种抗菌药物的耐药率高于非ICU。临床应根据相应流行病学数据,制定针对性的经验治疗策略,并及时根据患者病原学检测结果,调整治疗方案。Objective To investigate the characteristics of composition and drug resistance feature of pathogens isolated from blood culture between intensive care unit(ICU)and non-ICU and to provide evidence for the rational use of antibiotics.Methods The composition and drug resistance of the pathogens,isolated in blood culture of ICU and non-ICU patients in a large tertiary hospital from January 2015 to December 2019,were analyzed.The characteristics of 6 critical multidrug-resistant organisms(MDRO)isolated from ICU and non-ICU patients were compared.Results A total of 3301 non duplicate strains of pathogens were isolated.Among them,2066 isolates were Gram-negative bacteria(accounting for 62.59%),990 isolates were Gram-positive bacteria(accounting for 29.99%)and 245 isolates were fungi(accounting for 7.42%).Totally 734 strains of pathogens were isolated from ICU,of which Acinetobacter baumannii was the most common(19.75%),while 2,567 strains of pathogens were isolated from non-ICU and Escherichia coli was the most common(22.59%).Among the 6 pathogens monitored in this study,631 MDRO isolates were detected,with a total detection rate of 33.46%(631/1886).The isolation rate of CRAB in Acinetobacter baumannii was the highest(94.42%)and the detection rate of CREC in Escherichia coli was the lowest(5.02%).The detection rate of the 6 major MDRO in ICU was 61.88%(276/446)and which was significantly higher than 24.65%(355/1,440)of non-ICU(χ^(2)=212.015,P=0).There were no significant differences in the resistance rates of Escherichia coli to common antibiotics between ICU and non-ICU isolates except cefazolin and aztreonam(P>0.05).In ICU,resistance rates of Klebsiella pneumoniae and Acinetobacter baumannii to commonly used antibiotics were higher than those in non-ICU except trimethoprim-sulfamethoxazole(P<0.05).Pseudomonas aeruginosa was more resistant to common antibiotics except amikacin than in non-ICU(P<0.05).The resistance rates of Staphylococcus aureus and coagulase-negative staphylococci to various antibiotics were signifi

关 键 词：血流感染 病原菌 重症监护病房 多重耐药 耐药性 

分 类 号：R978.1[医药卫生—药品] R446.5[医药卫生—药学]