神经外科重症监护室大肠埃希菌的感染分布及耐药性分析

摘要:目的　了解神经外科监护室（Neurosurgery Intensive Care Unit，NSICU）大肠埃希菌的分布及耐药性变迁，为临床治疗提供依据。方法　分析2011年1月-2013年12月95株大肠埃希菌的分布及药敏实验结果，收集数据进行统计分析。结果　45株（47.4%）大肠埃希菌菌菌种来自痰标本，36株（37.9%）来自尿标本。2011年共检出大肠埃希菌23株，其中超广谱β-内酰胺酶（Extended Spectrum Beta-Lactamases，ESBLs）菌株9株，占39.1%，2012年共检出32株，ESBLs17株，占53.1%，2013年检出40株，ESBLs26株，占65%。2011-2013年，ESBLs阴性的大肠埃希菌对头孢他啶的耐药率分别为50%、60%和64.3%，ESBLs阳性的耐药率分别为88.9%、100.0%和100.0%，明显高于ESBLs阴性细菌；菌株总体耐药率分别为73.9%、81.3%和87.5%，呈逐年上升趋势。其余β-内酰胺类抗菌药物亦有这种趋势。目前尚未发现对碳青霉烯类抗菌药物耐药的大肠埃希菌菌株。结论　大肠埃希菌对多种抗菌药物呈多药耐药性，应加强对大肠埃希菌耐药性的检测，加强医务人员的手卫生，加强对重症患者的护理，加强NSICU的消毒和管理，合理应用抗菌药物。

Infection distribution and drug resistance of Escherichia coli in patients in neurosurgical intensive care unit

Abstract: Objective To investigate the distribution and drug resistance of clinical isolates of Escherichia coli from NSICU, and to provide evidence basis for the clinical therapy of infections. Methods We determined and analyzed the distribution and drug resistance to 18 antibiotics on 95 strains of E.coli from January 2011 to December 2013. Results 45 strains of E.coli came from sputum, 36 from urine. In 2011, 23 strains of E.coli were detected, 9 strains of extended spectrum β-lactamase (ESBLs) accounted for 39.1%. In 2012, 17 strains of ESBLs from 32 accounted for 53.1%. In 2013, 26 strains of ESBLs from 40 accounted for 65%. During 2011 to 2013, ESBLs negative E.coil resistance rates of ceftazidime were 50%, 60%, 64.3%, respectively. ESBLs positive resistance rates were 88.8%, 100.0%, 100.0%, respectively, higher than ESBLs negative bacteria significantly. The resistance rates of overall strains were 73.9%, 81.3%, 87.5%, which showed an increasing trend. The rest β-lactam antimicrobial agents also had this trend. Fortunately, the strains resistant to carbapenem antibacterial drugs have been found. Conclusion The drug resistant rates of E.coli were rather high; monitoring for drug resistance of E.coli should be strengthened; the disinfection and hands disinfection of medical staffs should be improved; the care to severe patients should been strengthened, and management of NSICU should be strengthened too, then antimicrobial drugs should be used more rationally.