ICU内中心静脉导管相关性血流感染病原菌分布及耐药性分析

目的了解ICU内中心静脉导管相关性血流感染(CRBSI)病原菌的分布特点及其耐药性,以指导临床合理用药。方法回顾性分析2009年1月至2011年12月ICU内CRBSI患者的病原菌分布和药物敏感试验资料,比较排位前7位细菌的耐药特征。结果 67例CRBSI患者共检出81株病原菌,其中革兰阳性(G+)菌40株(49.4%),革兰阴性(G-)菌38株(46.9%),真菌3株(3.7%)。引起CRBSI的主要病原菌依次为凝固酶阴性葡萄球菌(27株,33.3%)、鲍曼不动杆菌(12株,14.8%)、肺炎克雷伯菌(9株,11.1%)、金黄色葡萄球菌(8株,9.9%)、铜绿假单胞菌(7株,8.6%)、大肠埃希菌(6株,7.4%)。G+菌中以表皮葡萄球菌为主,G-菌中以鲍曼不动杆菌为主。G+球菌对万古霉素的耐药率为0,G-杆菌对碳青霉烯类最为敏感。结论近3年来ICU内CRBSI病原菌以表皮葡萄球菌及鲍曼不动杆菌为主,且鲍曼不动杆菌耐药率较高。

Species Distribution and Antibiotic Resistance of Pathogens from Catheter-related Bloodstream Infections in Intensive Care Unit

Objective To investigate the species distribution and antibiotic resistance of pathogens from catheter-related bloodstream infections （CRBSI） in intensive care unit （ICU）, to provide evidence for the guidance of clinical rational administration. Methods A retrospective analysis was performed to review the microbiological and susceptibility test data of all CRBSI patients in ICU from January 2009 to December 2011. The patterns of antibiotic resistance among the top seven bacteria were compared. Results 67 eases of CRBSI were detected with 81 strains, including 40 Gram-positive （ G~ ） bacteria （49.4%） , 38 Gram- negative （G-） bacteria （46. 9% ）, and 3 fungi （3.7%）. The main pathogens causing CRBSI were coagulase negative Staphylococci （ 27 strains, 33.3% ） , Acinetobacter baumannii （ 12 strains, 14. 8% ） , Klebsiella pneumoniae（ 9 strains, 11.1% ）, Staphylococcus aureus （ 8 strains, 9. 9% ）, Pseudomonas aeruginosa （ 7 strains, 8.6% ）, Escherichia coli （6 strains, 7.4% ）, suggesting that Staphylococcus epidermidis was predominant pathogenic G＋ bacteria, and Acinetobacter baumannii was predominant G- bacteria. The antibiotic resistance tests demonstrated that isolated G- bacillus was highly sensitive to carbopenem, while vancomycin-resistant G ~ bacteria were not found. Conclusions Within the latest 3 years, the predominant pathogens of CRBSI in ICU are Staphylococcus epidermidis and Acinetobacter baumannii. Acinetobacter baumannii exhibited high drug resistance to all antibiotics.