地震后一月与地震前ICU革兰阴性杆菌医院感染病原菌分布及耐药特点

目的 总结5.12汶川大地震后一月内我院ICU病房医院感染革兰阴性菌的菌群分布和耐药特点,并且同既往的数据资料对比分析,了解耐药变迁情况.方法 回顾分析2008年5月12日至6月12日汶川地震后一月内我院ICU病房住院患者革兰阴性菌医院感染病原菌分布及药敏情况,并同地震前相关资料进行比较分析;通过MicroScan Walk away 96SI或PHOENIX~(TM)100全自动细菌鉴定及药敏分析系统,同时进行手工鉴定.结果 地震后一月内伤口感染所占比重明显增加,从地震前的7.9%上升到20.2%,但呼吸道感染仍然是最主要的医院感染.地震后一月ICU病房分离率最高的前三位医院感染革兰阴性杆菌依次为不动杆菌属细菌(36.2%),铜绿假单胞菌(22.7%),克雷伯菌属细菌(12.3%).与地震前相比,地震后一月各菌属的耐药性有不同程度的变化,亚胺培南仍是治疗大肠埃希菌和克雷伯菌属细菌的最敏感药物;铜绿假单胞菌对头孢他啶的耐药率明显增加,但对阿米卡星有较高的敏感性;不动杆菌属细菌对亚胺培南的耐药率呈上升趋势,但对加替沙星和头孢西丁有较高的敏感性.克雷伯菌属和大肠埃希菌超广谱β-内酰胺酶(ESBLs)的发生率从地震前的52.6%和48.8%升高到地震后一月的55.0%和87.5%.结论 地震后一月与地震前ICU病房病原菌的耐药性均有一定程度变化,因此应动态监测细菌耐药性,根据药敏试验结果选用有效抗菌药.大量的外伤伤员可能是导致地震后一月ESBLs发生率增加的原因之一,这提示在重大灾难事故中要注意预防医院感染,尤其是产ESBLs细菌在重症监护室的扩散.

Change in Distribution of Pathogens and Nosocomial Antibiotic Resistant Gram-negative Bacilli Infection in Intensive Care Units One Month after an Earthquake

Objective To investigate the change in distribution of pathogens and nosocomial antibiotic resistant Gram-negative Bacilli infection in intensive care units one month after an earthquake.Methods A retrospective survey on the distribution of nosocomial Gram-negative bacilli infection in intensive care units before and one month after the Wenchuan Earthquake was conducted in the West China Hospital.MicroScan Walkaway 96SI or PHOENIX~(TM)100 Automatic System in combined with manual identification,was employed to identify the Gram-negative bacilli infection and antibiotic resistance.Results The proportion of wound infection increased from 7.9% to 20.2% one month after the earthquake, but infection in respiratory tract stayed the most common infection.The common pathogens included Acinetobacter spp.(36.2%), Pseudomonas aeruginosa (22.7%), and Klebsiella spp.(12.3%) before the earthquake.One month after the earthquake, Imipenem remained highly sensitive against Escherichia coli and Klebsiella.spp., while their resistance to ceftazidime increased.Amikacin became the most sensitive antibiotics against Pseudomonas aeruginosa.Acinetobacter spp.had increased resistance to imipenem, but was highly sensitive to gatifloxacin and cefoxitin.The prevalence of extended spectrum β-lactamases (ESBLs) in Klebsiella spp.and Escherichia coli increased from 52.6% and 48.8% before the earthquake to 55.0% and 87.5% one month after the earthquake, rspectively.Conclusion There is a significant change in distribution of pathogens and nosocomial antibiotic resistant Gram-negative Bacilli infection in intensive care units one month after the Earthquake, which might be associated with a sudden increase in injured patients.It is essential to regularly monitor the resistant rate of bacilli to antibiotics.