重症监护室医院感染主要病原学分布及其耐药性分析

目的: 分析重症监护室(ICU)医院感染主要病原学分布及其耐药情况。方法: 对124例医院感染患者的病原学资料进行分析。结果: 共检测阳性标本178份,其中分离出革兰阴性(G-)杆菌142株,革兰阳性(G+)球菌15株,真菌21株。G-杆菌中最常见的依次为:铜绿假单胞菌、肺炎克雷伯菌肺炎亚种、鲍曼不动杆菌和洋葱伯克霍尔德菌。G+球菌中最常见的依次为:金黄色葡萄球菌、溶血葡萄球菌和粪肠球菌等。真菌中最常见的依次为:白假丝酵母菌、光滑假丝酵母菌等。铜绿假单胞菌仅头孢哌酮/舒巴坦、阿米卡星、妥布霉素和多黏菌素E耐药率<30%。肺炎克雷伯菌耐药率普遍>40%,耐药率<45%有阿米卡星、环丙沙星、妥布霉素和复方磺胺甲口恶唑等。鲍曼不动杆菌耐药率<20%有头孢哌酮/舒巴坦、亚胺培南和美洛培南,其他抗生素耐药率均>70%。未发现对万古霉素、替考拉宁耐药的金黄色葡萄球菌和溶血葡萄球菌。白假丝酵母对常用抗真菌药物表现为较高敏感性。结论: ICU 医院感染病原菌以G-杆菌为主,细菌耐药普遍,密切监测ICU医院感染的常见致病菌及其对抗生素的敏感性,对指导临床合理用药,提高临床抗感染治疗效果十分重要。

Distribution and drug resistance of the major pathogens of nosocomial infection in intensive care unit

Objective: To investigate the distribution and drug resistance of major pathogens of nosocomial infection in intensive care unit(ICU).Methods: The pathogens data of 124 patients with nosocomial infection in ICU were retrospectively analyzed.Results: Among 178 samples,124 strains of Gram-negative(G-) bacilli(79.8%),15 strains of Gram-positive(G+) bacilli(8.4%) and 21 strains of fungus(11.8%) were found.The most common Gram-negative bacilli,in turn,was followed by Pseudomonas aeruginosa,Klebsiella pneumoniae,Acinetobacter baumannii and Burkholderia cepacia.The most common Gram-positive bacteria,in turn,was Staphylococcus aureus,Staphylococcus haemolyticus and Enterococcus faecalis.The most common fungus,in turn,was Candida albicans and Candida glabrata.The resistance rates of Pseudomonas aeruginosa to cefoperazone/sulbactam,amikacin,tobramycin and polymyxin E were less than 30%.The drug resistance rate of Klebsiella pneumoniae was more than 40%,its resistance rates to amikacin,Ciprofloxacin,tobramycin and cotrimoxazole were less than 45%.The resistance rates of Acinetobacter baumannii to cefoperazone/sulbactam,imipenem and meropenem were less than 20%,its resistance rates to other antibiotics were more than 70%.The resistance of Staphylococcus aureus and Staphylococcus haemolyticus to vancomycin and teicoplanin was not found.The Candida albicans was high sensibility to common antifungal drug.Conclusions: The main pathogen of nosocomial infection in ICU is Gram-negative bacilli,and the bacteria resistance to antibiotics is common.Close monitoring the common pathogenic bacteria and its sensibility to antibiotics in ICU is important in guiding the rational use of medicines and improving the curative effects of anti-infection.