ICU病房医院感染病原菌的调查分析

目的 了解综合性ICU医院感染的流行病学及细菌耐药性，为临床治疗感染性疾病提供可靠的科学依据。方法 对我院ICU病房2000年1月～2001年12月所有临床标本分离的病原菌进行耐药性分析。结果 ICU医院感染中以G^-杆菌为主，占86．8％，其次为G^-菌占13．2％。G^-杆菌中以产超广谱p内酰胺酶(ESBL)的肠杆菌科细菌为主占G^-杆菌的23．9％，占肠杆菌科细菌总数的71．3％，其次为铜绿假单胞菌占22．6％。G^-菌均为金黄色葡萄球菌，以耐苯唑金黄色葡萄球菌(MRSA)为主占86．5％。G^-杆菌中铜绿假单胞菌对氨曲南的耐药率最高为90％，对头孢他啶的耐药率最低为15％，对亚胺培南的耐药率为19％；ESBL及不动杆菌对亚胺培南的耐药率为0。不动杆菌对头孢哌酮、头孢哌酮，舒巴坦、氨曲南、哌拉西林、阿莫西林，棒酸、阿米卡星、环丙沙星耐药率最高均为100％，对头孢他啶、头孢吡肟的耐药率也高达88％；ESBL对含酶抑制剂的复合药阿莫西林，棒酸和头孢哌酮，舒巴坦的耐药率为80％以上，同时对多种抗生素呈交叉耐药。G^-菌对11种抗生素的耐药率均在90％以上，对复方新诺明耐药率为16％，只对万古霉素无1例耐药。结论 合理使用及严格限定抗生素的应用指征，对延缓细菌耐药性的产生以及个别多重耐药菌株的传播与流行至关重要。

Investigation and analysis on bacteria of nosocomial infection in ICU

Objective To search for the prevalence of nosocomial infection an d the change of drug resistance in ICU and to furnish reliable scientific proof for treatment of infectious disease. Methods The drug resistance of bacteria isolated from ICU was analy sed from January 2000 to December 2001. Results The most bacteria of nosocomial infection in ICU were still gram-negative bacte ria (86.8%) and then gram-positive bacteria ( 13.2 %).In gram-negative bacte ria ESBL-producing bacteria of Enterobateriaceae was the major one (23.9%),then Pse udomonas aeruginosa (22.6%).In gram-positive bacteria Staphylococcus aureus was the major one and among the isolated strains MRSA were 86.5%.The resistance rat e of Pseudomonas aeruginosa for aztreonam was 90%,for imipenem was 19% and for c eftazidime was 15%.The resistance rate of ESBL-producing bacteria and Acinetoba cter for imipenem was 0.The resistance rate of later for cefoperazone,ciprofloxa cin,aztreonam,piperacillin,amikacin,cefoperazone/sulbactam,amoxicillin/clavulana t were 100% and for ceftazidime,cefepime were 88%.The resistance rate of ESBL-p roducing bacteria for amoxicillin/clavulanate and cefoperazone/sulbactam were mo re than 80%.The resistance rate of gram-positive bacteria for eleven kinds o f antibiotics were more than 90%,for trimethoprim/sulfamethoxazole was 16% and f or vancomycin was 0. Conclusion It is very important to use the antibiotics rationally a nd it can delay the prolaction of drug resistance and epidemic of the multidrug resistance bacteria.