重症医学科医院感染病原菌分布及耐药分析

目的 调查分析重症医学科(ICU)医院感染的病原菌分布、耐药状况及变化趋势,为危重患者抗感染治疗提供依据.方法 对ICU2006年9月-2008年8月所分离出的病原菌菌株及其耐药性进行回顾性调查分析,并比较不同时期(A组:2006年9月-2007年8月,B组:2007年9月-2008年8月)病原菌耐药率差异.结果 共检出病原菌255株,其中革兰阴性杆菌183株(71.76%),以非发酵革兰阴性杆菌科和肠杆菌科细菌为主,主要包括铜绿假单孢菌(58/183,31.69%),鲍曼/溶血不动杆菌(39/183,21.31%),大肠埃希菌(32/183,17.49%)等,多见于下呼吸道感染;革兰阳性菌51株(20.0%),以葡萄球菌属和肠球菌属为主,主要见于下呼吸道和腹腔感染;真菌21株(8.24%),包括白色念珠菌(9/21,42.85%)和光滑念珠菌(8/21,38.10%)等.病原菌对常用抗菌药物耐药严重,耐药率呈上升趋势,B组铜绿假单胞菌对美罗培南和亚胺培南的耐药率及鲍曼不动杆菌对亚胺培南的耐药率较A组显著增加(P<0.05). 结论 ICU医院感染最多见于下呼吸道,以革兰阴性杆菌为主,对常用抗菌药物耐药严重,且耐药率呈上升趋势,需严格掌握抗菌药物使用原则,根据药敏选用抗菌药物.

Distribution of pathogenic bacteria of hospital acquired infections in intensive care unit and its drug-resistances

Objective Investigating the distribution of pathogenic bacteria of hospital acquired infections in ICU and the tendence of its drug-resistances provided evidence for treatment of critical patients in anti-infective therapy. Methods A retrospective investigation analysis was made for all the isolated bacteria and its drug-resistance in ICU from Sep 2006 to Aug 2008, then the resistance rates of difference groups were compared (group A: Sep 2006-Aug 2007, group B: Sep 2007-Aug 2008). Results 255 bacterial strains were isolated including 183 strains of Gramnegative bacteria(71.76%), 51 strains of Gram-positive bacteria (20.0%)and 21 strains of fungi(8.24%). The Gramnegative bacteria consisted of non-fermentative Gram-negative bacilli and enteric bacilli, which were isolated mainly from lower respiratory tract infection, including Pseudomonas aeruginosa(58/183, 31.69%), Acinetobacter baumannii/Acinetobacter haemolyticus(39/183, 21.31%)and Escherichia coli (32/183, 17.49%), etc. The Gram-positive bacteria consisted of Staphylococcus and Enterococcus, which were isolated mainly from lower respiratory tract infection and enterocoelia infection. The fungi included Candida albicans(9/21, 42.85%)and Candida glabrata(8/21, 38.10%) etc. Bacteria were highly resistant to commonly used antimicrobials and the trendence of resistant rate was increasing. The resistant rate of Pseudomonas aeruginosa against meropenem and imipenem and the resistant rate of Acinetobacter baumannii/Acinetobacter haemolyticus against imipenem were notablely higher in group B than in group A(P<0.05). Conclusion The pathogens are mainly isolated from lower respiratory tract, the majority of pathogens were Gram-negative bacteria, and the trendence of resistant rate was increasing in ICU. The rational selection and use of antibiotics should base on the results of monitoring of bacterial resistance and drug-sensitivity tests.