2013－2015年重症监护室常见病原菌耐药性变迁

目的：分析2013－2015年该院重症监护室临床标本分离病原菌的耐药性变迁，指导临床合理用药。方法细菌鉴定采用美国BD公司生产的Phoenix 100全自动细菌药敏鉴定仪，补充药敏试验采用纸片扩散法，药敏结果根据美国临床和实验室标准协会标准进行判读，数据使用 WHONET5．6软件进行统计分析。结果2013－2015年该院总共分离出病原菌1366株，其中革兰阴性细菌占90．9％，革兰阳性细菌占7．5％，真菌占1．6％。排名前4位的病原菌分别是肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌及黏质沙雷菌，分别占34．3％、18．6％、12．5％、9．8％。2013－2015年除复方磺胺甲唑外，鲍曼不动杆菌对其余各抗菌药物耐药率均在70．0％以上，铜绿假单胞菌对氨曲南的耐药率最高（70．7％），2013－2015年间除头孢他啶、阿米卡星、复方磺胺甲唑和氯霉素外，黏质沙雷菌对其他抗菌药物的耐药率均在80．0％以上。结论重症监护室常见病原菌对抗菌药物耐药率居高不下，耐药情况严重，多重耐药菌株检出量增多，临床需合理使用抗菌药物，加强院感防控。

Drug resistance change of common pathogenic bacteria in ICU during 2 0 1 3-2 0 1 5

Objective To analyze the drug resistance change of pathogenic bacteria isolated from ICU during 2013-2015 so as to guide reasonable drug use in clinic.Methods The bacterial identification adopted the Phoneix 100 automatic bacterial susceptibil-ity identification system produce by BD Company,the drug susceptibility testing results was interpreted by CLSI and the data of drug susceptibility testing results were performed the statistical analysis by WHONET5.6 software.Results A total of 1 366 strains of pathogenic bacteria were isolated in this hospital during 2013-2015,in which Gram-negative bacteria accounted for 90.0%,Gram-positive bacteria accounted for 7.5% and fungi accounted for 1.6%.The top four pathogens were Klebsiella pneu-moniae,Acinetobacter(A.)baumannii,Pseudomonas(P.)aeruginosa and Serrati(S.)marcescens,accounting for 34.3%,18.6%, 12.5% and 9.8% respectively.Except for trimethoprim-sulfamethoxazole,the resistance rates of A.baumannii to other antibacterial drugs were more than 70.0%;the drug resistance of P.aeruginosa to aztreonam was highest(70.7%);except for ceftazidime,ami-kacin,trimethoprim-sulfamethoxazole and chloramphenicol,the resistance rates of S.marcescens to other antibacterial drugs were more than 80 .0%.Conclusion The resistance rates of common pathogenic bacteria in ICU to antibacterial drugs stay at the high level,the drug resistance situation is serious,the detection amount of multi-drug resistant bacterial strains is increased.Clinic should rationally use antibacterial drugs.The prevention and control of nosocomial infection should be strengthened.