ICU与非ICU的革兰阴性菌分布与耐药性分析

目的 了解医院重症监护病房(ICU)与非ICU革兰阴性菌分布及耐药性.方法 使用恒星HX-21细菌鉴定药敏分析仪对分离的革兰阴性菌进行鉴定和药敏分析,运用WHONET 5.4和SPSS19.0软件对资料进行分析.结果 10192株革兰阴性菌中,ICU检出3120株,占30.6％,非ICU检出7072株,占69.4％；检出率较高的4种革兰阴性菌为鲍氏不动杆菌、大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌,分别占25.3％、18.1％、17.6％、9.9％,ICU以非发酵菌占优势,排序前4位的革兰阴性菌依次为铜绿假单胞菌、鲍氏不动杆菌、大肠埃希菌、肺炎克雷伯菌,非ICU则为鲍氏不动杆菌、大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌；ICU分离株普遍比非ICU分离株耐药,多数菌株对亚胺培南耐药率＜30.4％,对β-内酰胺抑制剂复合剂耐药率＜24.1％,维持低水平耐药率.结论 ICU分离的病原菌以非发酵革兰阴性菌为主,且ICU耐药率普遍高于非ICU,临床治疗应区别对待,加强各区域细菌耐药性监测.

Distribution and drug resistance of gram-negative bacteria in ICU and non-ICUs

OBJECTIVE To investigate the distribution and drug resistance of gram-negative bacteria in ICU and non-ICUs.METHODS The bacterial identification and drug susceptibility testing were performed by HX-21,and statistical analysis of the data was performed by using WHONET5.4 and SPSS19.0 software.RESULTS Of 10 192 strains of gram-negative bacteria,there were 3120(30.6%) strains isolated from ICU and 7072(69.4%) strains isolated from non-ICUs;Acinetobacter baumannii,Escherichia coli,Pseudomonas aeruginosa and Klebsiella pneumoniae were the top 4 gram-negative bacteria,accounting for 25.3%,18.1%,17.6%,and 9.9%,respectively;non-fermenting bacteria were dominant in ICU,the top 4 gram-negative bacteria were in turn as follows: P.aeruginosa,A.baumannii,E.coli and K.pneumoniae and the top 4 gram-negative bacteria in non-ICUs were in turn as follows: A.baumannii,E.coli,K.pneumoniae and P.aeruginosa;the drug resistance rates of gram-negative bacteria in the ICU were generally higher than those in non-ICUs,the drug resistance rate of most of the isolates to imipenem was less than 30.4%,the resistance rate to β-lactam inhibitors was less than 24.1%,maintaining a low level resistance.CONCLUSION Non-fermenting gram-negative bacteria are predominant pathogens isolated from ICU,whose drug resistance rates are generally higher than the isolates from non-ICUs,the treatments should be treated differently,and the surveillance of bacterial resistance should be intensified.