ICU患者病原菌流行特点及耐药性分析

目的了解ICU病原菌流行特点和耐药特点，为ICU医感染控制提供方法以及为合理应用抗生素提供依据。方法对2010年1月至2011年9月30日ICU患者的细菌的流行特点、耐药特点进行分析。结果共分离到175株病原菌，标本来源以痰标本为主。共144株，占82．3％；革兰阴性杆菌以铜绿假单胞茵最多，占21．14％，肺炎克雷伯菌次之16％；革兰阳性球菌以金黄色葡萄球菌为主16．57％．金黄色葡萄球菌耐甲氧西林菌株占75．9％，凝固酶阴性葡萄球菌耐甲氧西林者为100％。肺炎克雷伯菌ESBLs的产生率为75％，鲍曼不动杆菌对头孢菌素和喹诺酮类药物耐药严重，对亚胺培南、美罗培南和孢哌酮／舒巴坦敏感率高。金黄色葡萄球菌、鲍曼不动杆菌发生ICU内医院感染的菌株分别占同类菌株的34．48％和37．5％。结论我院ICU分离的细菌以革兰阴性杆菌为主，构成比排前四位的依次是铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌扣鲍曼不动杆菌，除了铜绿假单胞菌耐药率相对较低，其他大部分细菌耐药严重。金黄色葡萄球菌、鲍曼不动杆菌发生ICU内医院感染的菌株占同类细茼总数的百分比较高。应重视多重耐药菌的预防隔离工作，密切观察重症监护病房的细菌流行状况，采取有效措施减少院内感染。

The epidemic characteristic of pathogens and drug resistance analysis in ICU patients

Objective To investigate the epidemic characteristic of pathogens isolated from ICU and drug resistance to antimicrobials, so as to provide guidance for reasonable application of antimierobials and measures of preventing nosocomials infection. Methods The epidemic characteristic and Antibiotic susceptibility data of of pathogens of ICU from January 2010 to September 2011 was analyzed. Results A total of 175 strains mainly come from sprum sample, which accounted for 82.3 % of the total. Most of the G- Bacilli were Pseudomonas aeruginosa strains（21.14 % ） and Klebsiella pneumoniae slxains （ 16 % ）. Staphylococcus anrens was the most dominant G ＋ cocci （ 16.57 % ）. Methicillin - resistant strains accounted for 75.9 % in S. au and 100 % in coagulase negative Staphylococcus. ESBLs producing strains was 75 % in K. pneu- moniae. Acinetobacter baumannii showed high resistantce to cephalosporins and fluoroquinolones but showed high sensitivity to imipenem, meropenem and cefoperazone/sulbactam. ICU aquried infection caused by Staphylococcus attreus and Acinetobacter baumannii accounted for 34.48% and 37.5% of the the same bacteria, respectively. Conclusions Most of patients in ICU are infected with Gram negative bacilli, The top five isolations were Pseudomonas aeruginosa, K. pneumonlae, Staphylocbceus aureus, and Acinetobacter baumannii. The situation of bee- teria resistance is very serious except Pseudomonas aeruginosa. ICU aquried infection due to Staphylococcus aureus and Acinetobaeter baumannil. accounted for a large percentage of the same pathogens. Epidemiological characteristics should be closely minitored and great emphasis should be placed on isolation for patients infected mulfidrug - resistant strains. Thus we can take effective measures to reduce and control nosoeomials infection.