ICU重症感染革兰阴性细菌耐药性分析与治疗探讨

目的了解笔者医院ICU重症感染革兰阴性细菌的菌种构成和耐药情况,为ICU合理应用抗生素提供依据。方法对2007年1月1日～12月31日笔者医院ICU重症感染革兰阴性细菌细菌学结果及其耐药情况进行统计和分析。结果分离出最常见的5种菌依次为:铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌、大肠杆菌、嗜麦芽窄食单胞菌、阴沟肠杆菌。菌群整体呈高耐药率,多重耐药菌株达52.5%,以鲍曼不动杆菌为著,除了对头孢哌酮/舒巴坦和丁胺卡那的耐药性为30%左右,对其余抗生素的耐药率达77.4%～95.2%。肺炎克雷伯杆菌、大肠杆菌、阴沟肠杆菌此3种细菌对碳青酶烯类耐药率最低,为0～11.1%;除了铜绿假单胞菌,其余细菌对头孢类抗生素耐药率达50%～95%;β-内酰胺酶抑制药复合制剂的耐药率多在50%以上。结论加强ICU病原菌病原学方面监测及耐药监测,了解其流行菌株菌种构成和耐药趋势,对指导临床合理用药,减少多药耐药菌产生,降低医院感染率,具有重要意义。

Drug-resistance Analysis and the Treatment of Severe Infection Caused by Gram-negative Bacteria in ICU

Objective To summarize the status of gram-negative bacteria which caused severe sepsis in intensive care unit and to provide the evidence for choosing antibiotics.Methods The data of gram-negative bacteria,which caused severe sepsis in ICU of Shanghai ChangZheng hospital from 1st Jan to 31st Dec 2007 was analyzed and the drug resistance was detected.Results Pseudomonas aeruginosa,acinetobacter baumannii,klebsiella,escherichia coli,stenotrophomonas maltophilia and enterobacter cloacae were the most common pathogen in ICU.All those bacteria show strong resistance to antibiotics,52.5% of which were multidrug resistant.Acinetobacter baumannii was predominant for its resistant rate of 77.4%-95.2% to a series of antibiotics,with a exception of cefoperazone/Sulbactam and Amikacin,klebsiella,escherichia coli and enterobacter show mild resistance to carbapenems,approximately 0-11.1%.All but pseudomonas aeruginosa were resistant to cephems with 50%-95% and the resistance to β-lactamase inhibitors was commonly over 50%.Conclusion Monitoring the epidemiology and bacteria resistance can provide the evidences for choosing antibiotics clinically,also can reduce the occurrence of multidrug resistance and nosocomial infection.