ICU和非ICU病房多重耐药菌检出及耐药性差异

目的了解重症监护病房(ICU)和非ICU多重耐药菌(MDRO)的检出情况及耐药性差异。方法分析某院2015年1月—2016年12月住院患者细菌培养标本检出的菌株,目标性监测6种MDRO检出情况,并对ICU和非ICU的6种MDRO检出及耐药情况进行比较。结果目标性监测的6种MDRO共检出1 013株,检出率为13.13%。ICU MDRO检出率为24.60%,高于非ICU的5.47%(P0.001)。检出的6种MDRO中主要为CRAB,占69.40%;不同病原菌中CRAB检出率最高,为55.75%。ICU检出的MDRO以CRAB为主(76.32%),非ICU也以CRAB为主(48.62%);ICU在监测的目标病原菌中MDRO检出率(47.95%)高于非ICU(8.02%),差异有统计学意义(P0.001)。ICU检出的大肠埃希菌对替卡西林/克拉维酸、头孢曲松、头孢噻肟、头孢吡肟、亚胺培南、美罗培南、阿米卡星、庆大霉素的耐药率均高于非ICU,对哌拉西林的耐药率低于非ICU,差异有统计学意义(均P≤0.05);ICU检出的肺炎克雷伯菌对除哌拉西林外的其他常用抗菌药物的耐药率均高于非ICU(均P0.05)。ICU检出的鲍曼不动杆菌和铜绿假单胞菌对常用抗菌药物的耐药率均高于非ICU(均P0.05)。ICU检出的金黄色葡萄球菌对苯唑西林、环丙沙星、四环素、利福平的耐药率高于非ICU(均P0.05),而屎肠球菌对喹奴普丁/达福普汀和四环素的耐药率低于非ICU(均P0.05)。结论 ICU的MDRO检出率高,对大部分抗菌药物的耐药率也高于非ICU,应加强ICU MDRO的监测,制定针对性的预防控制措施。

Difference in detection results and antimicrobial resistance of multidrug resistant organisms in intensive care unit and non intensive care unit

ObjectiveTo understand detection results and difference in multidrug resistant organisms (MDROs) in intensive care unit (ICU) and non ICU. MethodsStrains isolated from clinical specimens of hospitalized patients in a hospital from January 2015 to December 2016 were analyzed, 6 kinds of MDROs were conducted targeted monitoring, isolation and antimicrobial resistance of 6 kinds of MDROs from ICU and non ICU patients were compared. ResultsA total of 1 013 strains of 6 kinds of MDROs were monitored, isolation rate was13.13%. Isolation rate of MDROs in ICU was higher than that of non ICU (24.60% vs 5.47%, P＜0.001）. Carbapenem resistant Acinetobacter baumannii(CRAB) was the main isolated MDROs, accounting for 69.40%；of different pathogenic organi sms, isolation rate of CRAB was the highest (55.75%). The main MDROs detected in ICU and non ICU were both CRAB, accounting for 76.32% and 48.62% respectively； Of isolated pathogens, isolation rate of MDROs in ICU was higher than that of non ICU (47.95% vs 8.02%, P<0.001). Antimicrobial resistance rates of Escherichia coli isolated from ICU to ticarcillin/clavulanic acid, ceftriaxone, cefotaxime, cefepime, imipenem, meropenem, amikacin, and gentamicin were all higher than that of non ICU, resistant to piperacillin was lower than non ICU, difference was statistically significant (all P≤0.05); resistance rates of Klebsiella pneumoniae from ICU to common antimicrobial agents (except piperacillin ) were all higher than non ICU(all P<0.05). Resistance rates of Acinetobacter baumannii and Pseudomonas aeruginosa from ICU to common antimicrobial agents were all higher than non ICU (all P<0.05). Resistance rates of Staphylococcus aureus isolated from ICU to oxacillin, ciprofloxacin, tetracycline, and rifampicin were all higher than non ICU (all P<0.05), and resistance rates of Enterococcus faecium to quinupristin/dafoeleptin and tetracycline were both lower than non ICU (both P<0.05). ConclusionIsolation rate of MDROs in ICU is high, resistance rates to most antimicrobial agents are also higher than non ICU, monitoring on MDROs in ICU should be strengthened, and according prevention and control measures should be formulated.