神经外科重症监护病房细菌流行及耐药性的20年监测

目的探讨神经外科重症监护病房(NSICU)医院获得性细菌感染的病原菌及其耐药情况的流行病学特点,指导临床诊疗。方法收集1995年1月~2014年11月北京天坛医院NSICU所有细菌分离株及药敏结果,统计分析其流行病学特点及耐药性变迁。比较2014年1~11月病房总体分离细菌与颅内感染分离细菌的分布及耐药性。结果 NSICU病房分离细菌5409株,其中痰标本91.57%、脑脊液3.85%、其他4.58%;革兰氏阴性菌3987株,革兰氏阳性菌1422株;排前5位的分别是铜绿假单胞菌1340株、不动杆菌属1330株、金黄色葡萄球菌1122株、克雷伯菌属588株、凝固酶阴性葡萄球菌209株。其中2007年1月~2014年11月颅内感染分离菌株革兰阴性菌66株,格兰阳性菌60株。革兰氏阴性菌感染中常见的不动杆菌属及铜绿假单胞菌大部分对常见的抗菌药包括碳青霉烯类抗生素广泛耐药,但颅内感染分离菌株对头孢唑肟及磺胺类敏感;革兰氏阳性菌感染中多见的葡萄球菌属对万古霉素依旧保持较高的敏感率。结论 NSICU的院内获得性感染中以肺部感染为主,致病菌主要为革兰氏阴性菌,广泛耐药的不动杆菌属及铜绿假单胞菌明显增多。而NSICU内的颅内感染的致病菌革兰阴性菌与阳性菌比例差别不大,且其耐药率与病房分离总体一致,但不动杆菌属对头孢唑肟及磺胺类敏感。

Distribution and antimicrobial-resistance of bacteria isolated in nosocomial infection in NSICU within 20 years

Objective To investigate the prevalence and antibiotic-resistance of pathogenic bacteria in nosocomial infection in the neurosurgical intensive care unit ( NSICU ) .Method The data of pathogenic bacteria isolated was recorded from NSICU of Beijing Tiantan Hospital , during January of 1995 to November 2014 .Epidemiology and antimicrobial-resistance of pathogenic bacteria were analyzed retrospectively .And infections in NSICU were in contrasted with intracranial infection in epidemiology of bacteria and antimicrobial-resisitance during January to November of 2014 . Results From the sites of infection , sputum account for 91 .57%, cerebrospinal fluid ( CSF ) 3 .85%and Others 4 .58%.Among all bacteria isolates ( n=5409 ) , Gram-negative cocci was 3987 isolates,and Gram-positive 1422 isolates, respectively.The most frequently isolated bacteria was Pseudomonas aeruginosa , which was 1340 isolates.Followed by Acinetobacter baumannii 1330 isolates, Staphylococcus aureusn 1122 isolate, Klebsiella pneumoniae 588 isolates, Coagulase-negative staphylococci 209 isolates.While Gram-negative was separated 66 isolates, and Gram-positive 60 isolates from intracranial infection from January of 2007 to November of 2014 . Acinetobacter and Pseudomonas aeruginosa occupied a large part in G -and were almost resistance to all common antibiotics , yet Acinetobacter in CSF was sensitive to ceftizoxime and sulfonamides . While Staphylococcus in G + was in high susceptibility to vancomycin .Conclutions Pulmonary infection caused by the G -was the main infection in NSICU .Pathogenic bacteria are mainly gram-negative bacterium , multi-drug resistance of acinetobacter and pseudomonas aeruginosa significantly increased .Gram-negative and Gram-positive that were separated from CSF in NICU had no difference,whatever their resistance rates to antibiotic was in accordance with that from NICU . However Acinetobacter in CSF was sensitive to ceftizoxime and sulfonamides .