重症监护病房感染病原菌分布及耐药性分析

目的调查医院重症监护病房患者临床感染病原菌的分布及耐药趋势,为临床合理选用抗菌药物提供依据。方法对2007年1月～2008年12月住院患者送检的各类标本中分离出的病原菌采用自动微生物鉴定仪Vitek compact进行细菌鉴定,K-B法进行药敏试验,Whonet 5.4软件对结果进行分析。结果在分离到的255株菌中,革兰氏阴性菌120株（47.1%）,革兰氏阳性菌75株（29.4%）,真菌60株（23.5%）。革兰氏阴性菌中非发酵菌所占比例较高（66.7%）,其中铜绿假单胞菌居首位（43.0%）,其次是鲍曼不动杆菌（17.0%）,大肠埃希氏菌、肺炎克雷伯菌及阴沟肠杆菌共22株（18.0%）,其中产超广谱内酰胺酶（ESBLs）比率〉70%;革兰氏阳性菌以金黄色葡萄球菌为主29株,耐甲氧西林金黄色葡萄球菌（MRSA）26株;真菌60株,主要为白色假丝酵母菌40.0%、热带假丝酵母菌23.0%和光滑假丝酵母菌22.0%。对5-氟胞嘧啶、两性霉素、氟康唑、伊曲康唑及氟利康唑均敏感。结论 ICU患者感染及多耐药严重,加强耐药性监测,合理使用抗菌药物十分重要。

Distribution and Antibacterial Resistance of Pathogens in Intensive Care Unit

Objective To investingate the tendency of bacterial distributeion and drug resistance of pathogens in ICU.then instruct clinical application of antibiotics reasonably.Methods The identifiction of bacteria,isolated from patients in ICU from Jan 2008 to Dec 2008,and antibiotic susceptibility by Vitek compact.Results A total of 255 pathogens strains were isolated,Grem-negative bacilli,Gram-postive cocci and fungiaccounted for 47.1%,29.4% and 23.5%,respectively.The most common pathogens of them were Pseudomonas aeruginosa（43.0%）,the second is Acinetobacter baumannii（17.0%）.Escherichia coli,Klebsiella pneumoniae and Enterobacter cloacae were 22 for 18.0%.The rate of the ESBLs were higher than 70.0%.The most common pathogens of Gram-postive cocci were Staphylo coccus.Metieillin-resistant strains of Staphylo coccus aureus accounted for 89.7%.There were 60 strains fungi.And all the fungi were sensitive to flucytosine,amphotericin B,fluconazole,itraconazole voriconazole Conclusion The infection and multidrum resistance of pathogens are serious in ICU.It is important and urgent to carry out surveillance of bacterial resistance for appropriately using antibiotics.