某ICU医院感染多重耐药菌构成及药敏分析

目的 观察分析本院重症医学科(ICU)医院感染多重耐药菌(MDRO)构成及药敏情况,为危重患者医院感染防治提供理论依据。方法对本科2010年3月1日～2014年3月1日医院感染MDRO情况进行回顾性调查。结果MDRO共120株,占院内细菌感染的55.30%,其中革兰阳性(G⁺)菌55.00%；居前5位者分别为粪肠球菌(24.20%)、金黄色葡萄球菌(20.80%)、鲍曼不动杆菌(17.50%)、大肠埃希菌(8.30%)及铜绿假单胞菌(6.70%)；嗜麦芽窄食单胞菌MDRO检出率最高,对复方新诺明、左氧沙星及环丙沙星较敏感；铜绿假单胞菌对阿米卡星最敏感(75.00%)；鲍曼不动杆菌呈泛耐药性,对美罗培南、亚胺培南及头孢哌酮/舒巴坦敏感性仅为42.10%、35.70%及21.10%；发现耐万古霉素的粪肠球菌及金黄色葡萄球菌；各类G⁺MDRO除对糖肽类抗生素高度敏感外,对米诺环素亦较敏感(59.30%~83.30%)。结论ICU多重耐药菌检出率高,耐抗菌药物种类广,需严格掌握抗菌药物使用原则并根据药敏选用抗菌药物,采取单间隔离、强化手卫生、有效环境消毒等措施预防和控制院内感染。

Composition and Drug Susceptibility Analysis of Multi-drug Resistant Bacteria in the ICU Nosocomial Infection

Objective To observe and analyze multiple drug-resistant bacteria(MORO) hospital infection and drug susceptibility in ICU,to provide basis for prevention and control of hospital infection in critical patients.MethodsA retrospective survey of MDRO infection was made in hospital ICU from March 2010 to March 2014.Results120 strains MDRO were detected and it accounted for 55.30% of nosocomial infection.The corporation of the Gram-positive(G⁺) bacteria were more(55.00%).The top 5 MDRO were Enterococcus faecalis (24.20%),Staphylococcus aureus (20.80%),Bauman Acinetobacter (17.50%),Escherichia coli (8.30%) and Pseudomonas aeruginosa (6.70%).The supreme prevalence of MDRO was the stenotrophomonas maltophilia(SMA).It has higher susceptibility to trimesulf,ofloxacin and ciprofloxacin.Pseudomonas aeruginosa is the most sensitive MDRO to Amikacin (75.00%).Bauman Acinetobacter shows extensive bacterial antibiotic resistance.The sensitivity of imipenem,meropenem and Cefoperazone/Shubatan were 42.10%,35.70% and 21.10%.One strain of Enterococcus faecali was resistant to vancomycin and one Staphylococcus aureus was too.Various Gram-positive MDRO is susceptible to minocycline (59.30%~83.30%).ConclusionThe detection rate of MDRO in ICU is high,the category of resistance to antimicrobial drugs is of large variety.The rational selection and use of antibiotics should be based on the results of monitoring of bacterial resistance and drug-sensitivity tests.Keeping the patients apart,strict medical facility sterilization and intensive hand hygiene are very important preventive measures for infections.