重症监护病房脓毒症患者病原菌的流行病学特征

目的了解重症监护病房中脓毒症患者常见的病原菌种类、分布及耐药情况,为脓毒症患者抗菌药物合理应用提供参考依据。方法回顾性收集2015年1月—2016年6月入住某院重症监护病房的脓毒症患者的临床资料、送检培养标本的病原菌检出及药敏试验结果,对资料进行分析。结果共选取175例脓毒症患者,检出241株病原菌,129株多重耐药菌;其中革兰阴性菌139株(57.68%)、革兰阳性菌68株(28.22%),真菌29株(12.03%);分离率居前5位的病原菌分别为大肠埃希菌(20.75%),肺炎克雷伯菌(14.11%),鲍曼不动杆菌(13.28%),白假丝酵母菌(12.03%),铜绿假单胞菌(9.54%)。检出率居前5位的多重耐药菌分别为鲍曼不动杆菌(29/32,90.63%)、屎肠球菌(16/20,80.00%)、肺炎克雷伯菌(24/34,70.59%)、葡萄球菌属(14/21,66.67%)、铜绿假单胞菌(14/23,60.87%)。大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶(ESBLs)菌株分离率分别为68.00%(34/50)和17.65%(6/34),大肠埃希菌对碳青霉烯类及β-内酰胺酶抑制剂耐药率低,肺炎克雷伯菌仅对替加环素敏感;鲍曼不动杆菌对抗菌药物呈普遍耐药,铜绿假单胞菌仅对多粘菌素敏感;肠球菌及葡萄球菌对糖肽类、利奈唑胺及替加环素敏感;白假丝酵母菌对抗真菌药物普遍敏感。结论该院重症监护病房脓毒症患者所分离的病原菌耐药率高,尤以鲍曼不动杆菌显著,酶抑制剂类、碳青霉烯类和糖肽类抗菌药物仍然是经验性抗感染治疗的有效药物。

Epidemiological characteristics of pathogens causing sepsis in patients in intensive care unit

ObjectiveTo understand species, distribution, and antimicrobial resistance of common pathogens from patients with sepsis in intensive care unit（ICU），and provide reference for rational application of antimicrobial agents in sepsis patients. MethodsClinical data of sepsis patients who were admitted to the ICU of a hospital from January 2015 to June 2016 were collected retrospectively, pathogenic detection and antimicrobial susceptibility testing results of specimens were analyzed. ResultsA total of 175 sepsis patients were selected, 241 pathogens were isolated, 129 of which were multidrug resistant organisms(MDROs); 139 (57.68%) were gram negative bacteria, 68 (28.22%) were gram positive bacteria, and 29 (12.03%) were fungi; the top 5 isolated strains were Escherichia coli (E. coli, 20.75%), Klebsiella pneumoniae (K. pneumoniae, 14.11%), Acinetobacter baumannii (A. baumannii, 13.28%), Candida albicans (C. albicans, 12.03%), and Pseudomonas aeruginosa (P. aeruginosa, 9.54%). The top five isolated MDROs were A. baumannii (29/32, 90.63%), Enterococcus faecium (16/20, 80.00%), K. pneumoniae (24/34, 70.59%), Staphylococcus spp. (14/21, 66.67%), and P. aeruginosa (14/23, 60.87%）. The isolation rates of extended spectrum β lactamases (ESBLs) producing E. coli and K. pneumoniae were 68.00%(34/50) and 17.65%(6/34) respectively, E. coli had low resistance rates to carbapenems and β lactamase inhibitors, K. pneumoniae was only sensitive to tigecycline; A. baumannii was generally resistant to antimicrobial agents, P. aeruginosa was only sensitive to polymyxin; Enterococcus spp. and Staphylococcus spp. were sensitive to glycopeptide, linezolid, and tigecycline; C. albicans was generally sensitive to antifungal agents. ConclusionResistance rate of pathogens isolated from sepsis patients in ICU in this hospital is high, especially A. baumannii. Enzyme inhibitors, carbapenems, and glycopeptide are still effective antimicrobial agents for empirical anti infection treatment.