重症监护病房与普通病房细菌分布及耐药性比较

目的：比较呼吸科重症监护病房（RICU）、外科重症监护病房（SICU）以及普通呼吸科病房检出细菌流行病学分布及耐药特点。方法：采用纸片扩散法（K—B法），对我院RICU、普通呼吸科病房、SICU患者中1523株分离细菌进行药敏试验，并用WHONET软件5-4进行分析。结果：1523株细菌中革兰阴性菌1112株（73．0％）：革兰阳性菌411株（27．0％）。RICU、普通呼吸科病房和SICU分别检出细菌383、441和699株．三大病房金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌（MRSA）流行率分别占96．7％、64.3％和98．4％，未检出对万古霉素或替考拉宁耐药株．SICU检出耐万古霉素屎肠球菌4株。肺炎克雷伯菌产超广谱B内酰胺酶（ESBLs）菌株在RICU、普通呼吸科病房和SICU的流行率分别为21．6％、10．6％和45．9％；非发酵菌分别占革兰阴性菌的75．0％、53．0％和54．0％。三大病房比较，普通病房各细菌耐药率均较低；RICU和SICU鲍曼不动杆菌仅对头孢哌酮-舒巴坦耐药率低（〈20％），对其余临床常用抗生素耐药率均高于50．0％；SICU检出铜绿假单胞菌对临床常用抗假单胞菌药物耐药率均高于40．0％。结论：三大病房检出细菌均以革兰阴性菌为主，多重耐药非发酵菌是常见细菌。葡萄球菌属在革兰阳性菌检出中占主导．已发现耐万古霉素屎肠球菌菌株。

Comparison of bacteria strains isolated from ordinary respiratory ward and intensive care units and their resistance to antibiotics

Objective To compare the bacteria strains isolated from respiratory intensive care unit （RICU）, ordinary respiratory ward and surgery intensive care unit （SICU） and their resistance to antibiotics in Shanghai Ruijin Hospital. Methods Kirby-Bauer method was used to test the drug sensitivity of bacteria strains isolated. The results were analyzed using WHONET 5.4 software. Results Of the 1 523 bacteria strains isolated, 73.0%（ 1 112/1 523）were gram-negative bacteria and 27.0% （411/1 523）were gram-positive bacteria. The number of strains of bacteria isolated from RICU, ordinary respiratory ward and SICU were 383,441 and 699 respectively. Of Staphylococcus aureus, 96.7%, 64.3% and 98.4% isolates were methicillin-resistant Staphylococcus aureus （MRSA） in these three wards respectively. No strain of vancomycin-resistant or teicoplanin-resistant Staphylococcus aureus was identified. Four strains of vancomycin-resistant Enterococcus faecium were detected in SICU. 21.6%, 10.6% and 45.9% of the Klebsiella pneumordae isolated from these three wards were extended-spectrum β-lactamases （ESBLs）-producing strains, respectively. Non-fermentative bacilli isolates accounted for 75.0%, 53.0% and 54.0% of gram-negative bacteria in these three wards respectively. Bacteria isolates from the general ward had the lowest antibiotic resistance rates. Acinetobacter baumannii isolated from RICU and SICU only had a low resistance rate to cefoperazone-sulbactam （〈20%）. To other commonly used antibiotic, the resistance rates were higher than 50.0%. The resistance rates of Pseudomonas aeruginosa isolated from SICU to commonly used antibiotics were higher than 40.0%. Conclusions The main pathogens isolated in clinical wards were gram-negative bacteria. Multiple drug resistant non-fermentative bacilli were commonly seen. Staphylococcus aureus was the leading pathogen of grampositive bacteria. Vancomvcin-resistant strains of Enterococcus faecium had been found.