2013—2017年ICU感染病原菌分布及耐药趋势分析

目的分析重症监护病房(ICU)感染病原菌分布及其耐药趋势,为ICU有效预防与控制医院感染提供依据。方法采用回顾性研究方法,收集我院2013—2017年综合ICU送检的25057份临床标本分离的病原菌进行细菌种类鉴定和药敏试验。结果分离病原菌6938株,其中革兰阴性菌5513株(79.46%),革兰阳性菌710株(10.23%),真菌715株(10.31%),排名前4位分别为鲍曼不动杆菌(31.65%)、肺炎克雷伯菌(15.90%)、铜绿假单胞菌(11.46%)和大肠埃希菌(6.31%)。真菌随着时间变化呈现下降后升高趋势,鲍曼不动杆菌、铜绿假单胞菌和大肠埃希菌呈现升高后下降趋势,而肺炎克雷伯菌呈现下降后升高趋势。分离出多重耐药菌1387株,前3位分别为鲍曼不动杆菌(84.21%)、肺炎克雷伯菌(8.22%)和铜绿假单胞菌(4.83%)。5年间多重耐药鲍曼不动杆菌分布率均显著高于肺炎克雷伯菌和铜绿假单胞菌(P=0),且在2016年检出率达最高,2013和2017年检出率最低;多重耐药肺炎克雷伯菌在2017年检出率达最高,2013年检出率最低;多重耐药铜绿假单胞菌5年间差异无统计学意义(P>0.05)。结论我院病原菌以革兰阴性菌为主,不同年份病原菌及其耐药性变化有所不同,应定期监测病原菌及其耐药性变迁,正确合理使用抗菌药物。

Distribution and multiple drug-resistance profiles of pathogens in ICU from 2013 to 2017

Objective To analyze the distribution and multiple drug resistance of pathogenic bacteria in intensive care unit (ICU). Methods A retrospective study was conducted to collect 25,057 clinical specimens of pathogenic bacteria isolated from our comprehensive ICU from 2013 to 2017 were collected for bacterial isolation and identification, and to analyze the distribution of pathogenic bacteria and drug sensitivity results were analyzed. Results A total of 6938 strains of pathogens were isolated, including 5,513 strains of gram-negative bacteria (79.46%), 710 strains of Gram-positive bacteria (10.23%) and 715 strains of fungi (10.31%). The top four were Acinetobacter baumannii (31.65%), Klebsiella pneumoniae (15.90%), Pseudomonas aeruginosa (11.46%) and Escherichia coli (6.31%). The fungus showed an increasing trend with time, and Acinetobacter baumannii, Pseudomonas aeruginosa and Escherichia coli showed a decreasing trend, while Klebsiella pneumoniae showed an increasing trend. A total of 1387 strains of multi-drug resistant bacteria were isolated. The first three were Acinetobacter baumannii (84.21%), Klebsiella pneumoniae (8.22%) and Pseudomonas aeruginosa (4.83%). The distribution rate of multi-drug resistantAcinetobacter baumannii was significantly higher than those of Klebsiella pneumoniae and Pseudomonas aeruginosa (P=0) in 5 years, and the highest detection rate was in 2016, the lowest detection rate were in 2013 and 2017. Multiple drug-resistant Klebsiella pneumoniae bacteria detection rate reached the highest in 2017 and the lowest in 2013. There was no significant difference in the multi-drug resistant Pseudomonas aeruginosa during the 5 years (P>0.05). Conclusion Gram-negative bacteria were the main pathogenic bacteria in ICU of our hospital. The changes of pathogenic bacteria and their drug resistance were different in different years. Monitoring the changes of pathogenic bacteria and their drug resistance regularly is