2019-2021年我院重症医学科病原菌感染特点及耐药性分析

目的 调查分析我院重症医学科(intensive care unit,ICU)患者感染的病原菌分布、耐药情况及变化趋势,同时与全国细菌耐药监测网比较,指导临床合理使用抗菌药物。方法 采用回顾性研究的方法,对2019-2021年ICU各类标本分离检出的病原菌,药敏结果进行统计分析。结果 共收集分离菌株2 088株,下呼吸道1 463株(占70.1%),血211株(占10.1%),中段尿115株(占5.5%)。2 088株分离菌株中,革兰阴性杆菌1 483株(占71.0%),革兰阳性菌527株(占25.2%),真菌78株(占3.7%)。革兰阴性杆菌中前四位分别为肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌、铜绿假单胞菌;革兰阳性菌中前三位依次是金黄色葡萄球菌、屎肠球菌、粪肠球菌;真菌以白色念珠菌为主。革兰阴性杆菌中对碳青霉烯类耐药率由高到低依次为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌,其中鲍曼不动杆菌对碳青霉烯类耐药率增长明显,超过80%;而铜绿假单胞菌对碳青霉烯类耐药率接近和超过20%。自2020年开始,肺炎克雷伯菌分离率呈上升趋势,占据第一位,对碳青霉烯类的耐药率低于20%,大肠埃希菌对碳青霉烯类较敏感。金黄色葡萄球菌耐苯唑西林的占27.3%~34.5%,均未发现利奈唑胺、万古霉素、替加环素耐药。结论 我院ICU患者病原菌来源主要为下呼吸道感染,其次是血流感染、尿路感染。病原菌以革兰阴性杆菌为主,其次为革兰阳性菌、真菌。对常用药物的耐药率呈增长趋势,但产超广谱β内酰胺酶、耐碳青霉烯类肺炎克雷伯菌分离率、耐药率均低于全国细菌耐药监测网数据,鲍曼不动杆菌对碳青霉烯的耐药率远高于全国细菌耐药监测网数据,其他细菌的耐药情况和全国基本持平。临床选择用药应根据自家医院的药敏结果。

2019-2021 pathogen infection characteristics and drug resistance analysis on patients from Intensive Care Unit of the Hospital

Objective To investigate and analyze the distribution of pathogenic bacteria, drug resistance and change trend of patients infected in the Intensive Care Unit (ICU) of our Hospital, to compare to the China Antimicrobial Surveillance Network for a clinical guidance of the rational use of antibiotics. Methods A retrospective study was performed to statistically analyze on the drug susceptibility results of pathogenic bacteria isolated from specimens of ICU patients from 2019 to 2021. Results A total of 2 088 strains of bacteria including 1 463 strains of bacteria for lower respiratory tract (70.1%), 211 strains of bacteria for blood (10.1%) and 115 strains of bacteria for midstream urine (5.5%) were collected and isolated. In the 2 088 strains of bacteria, there were 1 483 gram-negative bacilli (accounting for 70.1%), 527 gram-positive bacilli (accounting for 25.2%) and 78 fungi (accounting for 3.7%). The top four gram-negative bacilli were Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli and Pseudomonas aeruginosa. The top three gram-positive bacteria were Staphylococcus aureus, Enterococcus faecium and faecal enterospherus. The fungi were mainly Candida albicans. The maximum drug resistance to carbapenems were Acinetobacter baumannii, followed by Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli. The resistance rate of Acinetobacter baumannii to carbapenem increased significantly, exceeding 80%. The resistance rate of pseudomonas aeruginosa to carbapenem was close to or more than 20%.The isolation rate of Klebsiella pneumoniae had been on the rise since 2020, accounting for the first place, its drug resistance rate against carbapenem was less than 20%, and Escherichia coli was sensitive to carbapenem. Staphylococcus aureus resistant to oxacillin was 27.3%-34.5%, and no linezolid, vancomycin or tigecycline resistance was found to be drug resistant. Conclusion The main pathogenic bacteria sources of patients from ICU of the Hospital are the bacteria for lower respiratory tract infection, followed by the bacteria for bloodstream infection and urinary tract infection. Pathogenic bacteria are mainly composed of Gram-negative bacilli, followed by Gram-positive bacteria and fungi. The growth trend of drug resistance shows increment growth, and the separation rate and drug resistance rate of extended-spectrum β-lactamase and carbapenem-resistant Klebsiella pneumonia are lower than the data of China Antimicrobial Surveillance Network, the drug resistance rate of Acinetobacter baumannii to carbapenem is higher than the data of China Antimicrobial Surveillance Network, and the drug resistance of other bacteria is basically equivalent to national level. The drugs selected for clinical practices shall follow nosocomial drug sensitivity results.