重症监护病房医院感染病原菌分布及耐药性分析

目的 了解重症监护病房医院感染的病原菌分布度其对抗菌药物的耐药性变化特征。方法 回顾性分析某院ICU病房2001～2005年从临床标本中分离到的院内感染病原菌及其耐药状况。结果 5年共在ICU病房患者中检出院内感染菌2356株，其中下呼吸道标本病原菌1918株（81．4％），泌尿系统标本241株（10．2％），其他部位标本197株（8．4％）。革兰阴性杆菌共计1 814株（77．0％），其中占前4位的分别为铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌；革兰阳性球菌共计308株（13．1％），以金黄色葡萄球菌为主；真菌共计229株（9．7％），以白色假丝酵母菌为主。5年间，MRSA检出率由62．9％上升到97．2％，大肠埃希菌ESBLs栓出率由35．4％上升到78．6％，肺炎克雷伯菌ESBLs检出率由24．4％上升到67．9％。药敏试验结果显示，革兰阴性菌对亚胺培南耐药率较低；金黄色葡萄球菌对抗菌药物耐药严重，对万古霉素和替考拉林耐药率为0；屎肠球菌的耐药率比粪肠球菌高；真菌对两性霉素B和5-氟胞嘧啶耐药率相对较低，对氟康唑、伊曲康唑耐药率较高。结论 ICU病房医院感染多见于下呼吸道和泌尿系统，主要致病菌常为多重耐药菌和条件致病菌，耐药性日趋严重，必须加强ICU病房医院感染的预防和控制。

Distribution of nosocomial infection pathogens and drug -resistance variation in intensive care unit

Objective To investigate the distribution of nosocomial infection pathogens and their drug-resistance variation in intensive care unit.Methods The bacterial strains isolated from clinical samples in some hospital ICU from 2001 to 2005 and the drug resistance was studied retrospectively.Results Among the isolated 2 356 strains,there were 1 918(81.4%) isolated from the lower respiratory tract,and 241(10.2%) from urinary tract.Gram-negative bacilli were 1 814(77.0%),including Pseudomonas aeruginosa,Klebsiella,Acinetobacter baumannii,Escherichia coli,etc.Gram-positive cocci were 308(13.1%),and Staphylococcus aureus were the main cocci.Fungi were 229(9.7%),and the most of the isolated fungi were Candida albicans.The isolated rate of MRSA increased from 62.9% to 97.2%,and E.coli with ESBLs increased from 35.4% to 78.6%,and Klebsiella with ESBLs increased from 24.4% to 67.9%. The results of susceptibility test suggested that the resistance rate of the Gram-negative bacilli to imipenem was low;Staphylococcus to vancomycin and teicoplanin was the lowest(0);Enterococcus faecium was higher than that of Enterococcus faecalis;Fungus to amphotericin B and flucoytosine were lower,but to fluconazole,itraconazole were higher.Conclusion The nosocomial infections in ICU occurred mainly in lower respiratory tract and urinary tract.The pathogenic bacteria were multidrug-resitant and conditioned pathogen.Antimicrobial agent resistance is more and more serious.Prophylaxis and control measures of NI must be enhanced.