ICU内血流感染的病原菌及耐药性分析

目的探讨ICU内血流感染的病原菌分布及耐药性情况，为临床合理选用抗生素提供依据。方法回顾性分析2010年1月～2012年4月我院ICU内18831份临床血流感染患者血培养标本，探讨常见病原菌的分布特点及耐药性。结果分离获得菌株560株，血培养标本分离率为10．81％，革兰阳性菌占61．1％，革兰阴性菌占31．1％，真菌占7．8％，居前五位的菌株依次为溶血葡萄球菌（20．0％），鲍氏不动杆菌（12．7％），表皮葡萄球菌（11．1％），肺炎克雷伯菌（6．4％），肠球菌属（8．0％）。MRSA和MRCNS的检出率分别为89．5％和97．2％，未发现万古霉素、替考拉宁耐药的金黄色葡萄球菌．肠杆菌科细菌及非发酵菌耐药现象普遍。结论革兰阳性菌是ICU内血流感染的主要病原菌，近年来真菌感染的发生率呈上升趋势，且血培养病原菌对常见抗菌药物的耐药现象普遍存在。

Pathogens and antibiotic resistance causing bloodstream infections in ICU

Objective To address the species distribution and antibiotic resistance among pathogens causing blood- stream infections in ICU, and to establish a basis for appropriate antibiotics usage. Methods The species distribution and antibiotic resistance of 18831 samples of blood culture in ICU from Jan 2010 to Apr 2012 were analyzed retro- spectively. Results A total of 560 strains were collected with separation rate of 10.81% in the study, which included Gram-positive strains （61.1%）, Gram-negativestrains （31.1%） and fungal strains （7.8%）. Of which staphylococcus haemolyticus （20%）, Acinetobacterbaumannii （ 12.7% ）, Staphylococcus epidermidis （ 11.1% ）, Klebsiellapneumoniae （6.4%）, and Enterococcus species（8.0%） were the most common ones. MRSA and MRCNS were 89.5% and 97.2%, respectively. No Staphylococcus strain was resistant to vancomycinorteicoplanin.Antibioticresistance of Enterobacteri- aceae and non-fermenting Gram-negative bacilli were significantly more common. Conclusion Gram-positive strains were the predominant pathogens in ICU bloodstream infections.Fungal infections keptincreasing, and the antibiotic re- sistancewereserious.