广西某综合三甲医院ICU病原菌分布及耐药变迁  

Distribution and Drug Resistance of Pathogenic Bacteria in ICU of a Tertiary Hospital in Guangxi

作　　者：陈丽坤 罗国兰[1] 覃兰[1] Chen Likun;Luo Guolan;Qin Lan(Department of Laboratory,The Fourth Affiliated Hospital of Guangxi Medical University,Liuzhou,Guangxi,545005,China)

机构地区：[1]广西医科大学第四附属医院医学检验科,广西柳州545005

出　　处：《黑龙江医学》2024年第23期2827-2831,共5页Heilongjiang Medical Journal

基　　金：2021年度广西壮族自治区卫健委西医类自筹经费科研课题(Z20210030);2023年度广西壮族自治区卫健委西医类自筹经费科研课题(Z-B20231401)。

摘　　要：目的:分析2018—2022年广西医科大学第四附属医院重症监护室(ICU)分离病原菌的分布特点及耐药趋势,为本地区ICU患者抗感染救治和院内感染防控提供参考依据。方法:对医院ICU各年度病原菌的分布及药敏情况进行回顾性分析。结果:5年共收集到临床分离菌4434株,其中革兰阴性菌3518株(79.3%),革兰阳性菌916株(20.7%),鲍曼不动杆菌检出率始终居于首位。大肠埃希菌对哌拉西林/他唑巴坦的耐药率逐年上升,对头孢曲松、左旋氧氟沙星的耐药率呈逐年下降,对耐碳青霉烯类耐药率较低。铜绿假单胞菌对环丙沙星耐药率呈下降趋势,对碳青霉烯类药物的平均耐药率分别为亚胺培南19.2%、美罗培南16.8%;超过80.0%的鲍曼不动杆菌呈多重耐药模式。2022年耐碳青霉烯肺炎克雷伯菌(CRKP)检出率骤然上升,从2021年的0.6%上升至2022年的37.9%。结论:ICU病区是医院感染的高发区。2018—2022年ICU临床分离致病菌以革兰阴性菌为主,2022年CRKP检出率猛增,耐药现状严峻,需要定期监测病原菌及其耐药趋势,合理使用抗生素,加强院内感染的预防和监控,尽可能避免多重耐药菌交叉传播。Objective:To analyze the distribution characteristics and drug resistance trends of pathogens isolated from the Intensive Care Unit(ICU)of The Fourth Affiliated Hospital of Guangxi Medical University from 2018 to 2022,in order to provide reference for anti infection treatment and hospital infection prevention and control of ICU patients in this region.Methods:A retrospective analysis was conducted on the distribution and drug sensitivity of pathogenic bacteria in the ICU of the hospital in each year.Results:Over the past 5 years,a total of 4434 clinical isolates were collected,including 3518 Gram negative bacteria(79.3%)and 916 Gram positive bacteria(20.7%).The detection rate of Acinetobacter baumannii always ranked first.The resistance rate of Escherichia coli to piperacillin/tazobactam has been increasing year by year,while the resistance rate to ceftriaxone and levofloxacin has been decreasing year by year.The resistance rate to carbapenems was relatively low.The resistance rate of Pseudomonas aeruginosa to ciprofloxacin was decreasing,and the average resistance rate to carbapenems was 19.2%for imipenem and 16.8%for meropenem,respectively.More than 80.0%of Acinetobacter baumannii showed a multidrug-resistant pattern.The detection rate of carbapenem resistant Klebsiella pneumoniae(CRKP)suddenly increased in 2022,from 0.6%in 2021 to 37.9%in 2022.Conclusion:ICU is a high-risk area for hospital infections.From 2018 to 2022,gram negative bacteria were the main pathogenic bacteria isolated in our hospital’s ICU clinical practice.The detection rate of CRKP increased sharply in 2022,and the current situation of drug resistance is severe.Regular monitoring of pathogenic bacteria and their drug resistance trends is necessary,rational use of antibiotics,strengthening prevention and monitoring of hospital infections,and minimizing the cross transmission of multiple drug resistant bacteria.

关 键 词：重症监护室 病原菌 耐药性 多重耐药 

分 类 号：R117[医药卫生—公共卫生与预防医学]