我院2009年7月-2012年6月急诊留观病房与急诊重症监护病房病原菌及体外药敏分析

目的:探讨急诊留观病房与急诊重症监护病房(EICU)感染病原菌分布及对常用抗菌药物的药物敏感性,为指导临床治疗提供依据。方法:对2009年7月-2012年6月我院急诊留观病房与EICU送检标本细菌培养分离的菌株及临床特点进行回顾性分析,选取高检出率的大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌和金黄色葡萄球菌进行抗菌药物敏感率调查。结果:急诊留观病房分离菌株430株,EICU分离菌株296株。急诊留观病房以金黄色葡萄球菌、大肠埃希菌、铜绿假单胞菌检出最多,EICU以大肠埃希菌、鲍曼不动杆菌、铜绿假单胞菌检出最多。大肠埃希菌在急诊留观病房仅对碳青霉烯类、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦敏感(敏感率>80%),而在EICU其对头孢他啶、头孢吡肟、碳青霉烯类、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、阿米卡星敏感(敏感率>80%);铜绿假单胞菌在急诊留观病房对头孢他啶、头孢吡肟、碳青霉烯类、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、阿米卡星敏感(敏感率>80%),而在EICU其仅对碳青霉烯类、头孢哌酮/舒巴坦敏感,敏感率>80%;鲍曼不动杆菌在急诊留观病房和EICU仅对碳青霉烯类、头孢哌酮/舒巴坦敏感(敏感率>80%);金黄色葡萄球菌在急诊留观病房和EICU对糖肽类抗菌药物敏感(敏感率为100%)。结论:急诊留观病房与EICU感染主要病原菌分布存在差别,主要病原菌耐药率均较高且呈多药耐药。碳青霉烯类、头孢哌酮/舒巴坦和糖肽类抗菌药物对革兰阴性菌和革兰阳性菌敏感率较高。急诊医师应参考药敏结果合理选用抗菌药物。

Analysis of Pathogens and Drug Susceptibility in vitro in Emergency Observation Ward and Emergency Intensive Care Unit of Our Hospital during Jul. 2009 --Jun. 2012

OBJECTIVE： To investigate the distribution of pathogens in emergency observation ward and emergency intensive care unit （EICU）, and to provide reference for clinical treatment. METHODS： The isolates of bacterial cultivation in emergency observation ward and EICU of our hospital during Jul. 2009 to Jun. 2012 were analyzed retrospectively. Escherichia coli, Pseudomohas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus with high detection rate were selected for antibacterial susceptibility test. RESULTS： 430 strains were isolated from emergency observation ward and 296 strains isolated from the EICU. S. aureus, E. coli and P. aeruginosa were mostly detected in emergency ward; E. coli, A. baumannii and P. aeruginosa were mostly detected in EICU. The sensitive rate of E. coli was above 80% to carbon carbapenem, piperacillin/tazobactam, cefoperazone/shubatan in emergency observation ward; that of E. coli was above 80% to ceflazidime, cefepime, carbon carbapenem, piperacillin/tazobactam, cefoperazone/sulbactam and amikacin in EICU. The sensitive rate of P. aeruginosa was above 80% to ceftazidime, cefepime, carbon carbapenem, piperacillin/tazobactam, cefoperazone/sulbactam and amikacin in emergency observation ward; that of P. aeruginosa was above 80% to only carbon carbapenem and cefoperazone/sulbactam in EICU. The sensitive rate of A. baumannii was above 80% to only carbon carbapenem, cefoperazone/sulbactam in emergency observation ward and EICU. The sensitive rate of S. aureus was 100% to glycopeptide antibiotics in emergency observation ward and EICU. CONCLUSIONS： There are differences in the distribution of infection pathogens in emergency observation ward and EICU. Main pathogenic bacteria shows high resistance rates and multidrug resistance. The sensitive rate of carbon carbapenem, cefoperazone/sulbactam and glycopeptide antibiotics are high to Gramnegative and Gram-positive bacteria. Emergency physicians should choose antibiotics reasonably referring to susceptibility results.