重症监护病房385株革兰阴性杆菌分析

目的了解重症监护病房(ICU)临床分离的革兰阴性杆菌的标本来源、菌种分布及对常用抗菌药物的耐药现状。方法对ICU分离的385株革兰阴性杆菌进行回顾性分析。结果385株革兰阴性杆菌79.0%来自痰标本。非发酵菌占分离菌的61.0%,鲍曼不动杆菌分离率最高,占27.0%。鲍曼不动杆菌耐药率除亚胺培南5.8%、哌拉西林/他唑巴坦48.1%外,其余多在80%以上;铜绿假单胞菌对三代头孢类耐药率43.2%~97.9%,对亚胺培南、阿米卡星的耐药率分别为42.1%和15.8%;肠杆菌科细菌对多种抗生素耐药率在40%以上,阴沟肠杆菌耐药性更为显著,亚胺培南表现良好的抗菌效果。大肠埃希菌、肺炎克雷伯菌中超广谱β内酰胺酶(ESBL s)阳性率分别为53.2%和55.6%。结论非发酵菌已成为ICU病人感染的最常见病原菌,革兰阴性杆菌对常用抗生素耐药性已达到相当严峻的程度,合理使用抗生素十分重要。

Analysis of 385 strains of Gram-negative bacilli in intensive care units

Objective To investigate the specimen source,the distribution and commonly used antibiotic-resistant conditions of Gram-negative bacilli from intensive care units(ICU).Methods A retrospective study of 385 strains of Gram-negative bacilli from ICU was performed.Results Among the 385 strains,79.0% were from sputum specimen.Nonzymophytes accounted for 61.0% of isolates.A.baumannii had the highest isolated rate(27.0%).Except imipenem and piperacillin/tazobactam in which the resistance rates were 5.8% and 48.1% respectively,most antibiotics resistance rates among A.baumannii isolates exceeded 80%.The third generation cephalosporins resistance rates among P.aeruginosa isolates ranged from 43.2% to 97.9%.P.aeruginosa resistance to imipenem and amikacin was 42.1% and 15.8% respectively.The resistance rates of Enterobacteriaceae to many kinds of antibiotics exceeded 40% and E.cloacae was more remarkable.Imipenem marked a good antimicrobial action.The positive rates of ESBLs in E.coli and K.pneumoniae were 53.2% and 55.6% respectively.Conclusions Nonzymophytes has become the most common pathogens.For the high level resistance of the Gram-negative bacilli to commonly used antibiotics,it is very important to rationally choose the antibiotics.