西安某医院重症监护室常见细菌的分布特征及耐药性分析  

Distribution and drug resistance profiles of common bacterial isolates in intensive care unit of a hospital in Xi’an

作　　者：刘泽世 张雪[1] 雷静 殷鉴 张彦平 耿燕[1] LIU Zeshi;ZHANG Xue;LEI Jing;YIN Jian;ZHANG Yanping;GENG Yan(Department of Laboratory Medicine,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi’an 710000,China)

机构地区：[1]西安交通大学第二附属医院检验科,西安710000

出　　处：《中国感染与化疗杂志》2024年第4期427-433,共7页Chinese Journal of Infection and Chemotherapy

基　　金：陕西省重点研发计划(S2023-YF-YBSF-0408)。

摘　　要：目的 了解西安交通大学第二附属医院重症监护室(ICU)常见临床分离菌的分布特点及其耐药性。方法 回顾性分析该院 ICU 2020年1月1日-2022年12月31日临床分离菌的抗菌药物敏感性试验结果。结果 2020-2022年ICU临床分离菌3 649株,其中革兰阳性菌1 344株(36.8%)、革兰阴性菌2 305株(63.2%)。其中克雷伯菌属540株(14.8%)、肠球菌属522株(14.3%)、凝固酶阴性葡萄球菌448株(12.3%)、不动杆菌属438株(12.0%)、大肠埃希菌424株(11.6%)。甲氧西林耐药金黄色葡萄球菌(MRSA)、甲氧西林耐药表皮葡萄球菌(MRSE)和甲氧西林耐药凝固酶阴性葡萄球菌(MRCNS)的检出率分别为76.1%、82.4%和69.9%。除甲氧苄啶-磺胺甲噁唑外,MRSA、MRSE和MRCNS的耐药率均明显高于MSSA、MSSE和MSCNS。未检出葡萄球菌属对万古霉素、利奈唑胺耐药菌株。肠球菌属中屎肠球菌的耐药率高于粪肠球菌。未发现对万古霉素耐药的肠球菌属;发现2株对利奈唑胺耐药的粪肠球菌。肺炎克雷伯菌对亚胺培南和美罗培南的耐药率最高,分别为38.4%和40.2%。大肠埃希菌对亚胺培南和美罗培南的耐药率均<2.0%,而阴沟肠杆菌对该两药的耐药率>10.0%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为27.1%和19.6%;但鲍曼不动杆菌对该两药的耐药率高,分别为86.0%和86.7%。结论 该院ICU肺炎克雷伯菌和鲍曼不动杆菌对碳青霉烯类耐药率较高,但肠杆菌目中其他细菌对碳青霉烯类仍较敏感,细菌耐药率低。肠球菌属中已发现有对利奈唑胺的耐药菌株,未发现与万古霉素交叉耐药。因此,加强病原菌耐药性监测,合理使用抗菌药物,可以有效控制医院感染。Objective To understand the distribution and drug resistance profiles of common clinical isolates in the intensive care unit(ICU)of a hospital in Xi’an.Methods A retrospective analysis was conducted on the antimicrobial susceptibility test results of clinical bacterial isolates in ICU of the Second Affiliated Hospital of Xi’an Jiaotong University from January 1,2020 to December 31,2022.Results A total of 3649 clinical isolates were isolated from the ICU,including 1344(36.8%)strains of Gram-positive bacteria and 2305(63.2%)strains of Gram-negative bacteria.The most common bacterial species were Klebsiella spp.(14.8%,540/3649),Enterococcus spp.(14.3%,522/3649),coagulase-negative Staphylococcus(12.3%,448/3649),Acinetobacter spp.(12.0%,438/3649),and Escherichia coli(11.6%,424/3649).The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),methicillin-resistant Staphylococcus epidermidis(MRSE),and methicillin-resistant coagulase-negative Staphylococcus(MRCNS)was 76.1%,82.4%,and 69.9%,respectively.MRSA,MRSE,and MRCNS strains showed significantly higher antimicrobial resistance rates than MSSA,MSSE,and MSCNS except for trimethoprim-sulfamethoxazole.No Staphylococcus strains were found resistant to vancomycin or linezolid.Enterococcus faecium demonstrated higher antimicrobial resistance rates than Enterococcus faecalis.No Enterococcus isolates were found resistant to vancomycin.Two strains of linezolid-resistant E.faecalis were identified.Klebsiella pneumoniae showed high resistance rates to imipenem and meropenem(38.4%and 40.2%,respectively).Less than 2.0%of the Escherichia coli strains were resistant to imipenem and meropenem,while more than 10.0%of the Enterobacter cloacae were resistant to imipenem and meropenem.About 27.1%and 19.6%of the Pseudomonas aeruginosa strains were resistant to imipenem and meropenem,respectively.Acinetobacter baumannii showed high resistance rates to imipenem and meropenem(86.0%and 86.7%,respectively).Conclusions K.pneumoniae and A.baumannii strains isolated from the intensive

关 键 词：重症监护室 药物敏感性试验 肺炎克雷伯菌 鲍曼不动杆菌 碳青霉烯类抗生素 

分 类 号：R378[医药卫生—病原生物学]