重症监护患者临床分离菌的分布及耐药性分析

目的:了解重症监护病房感染患者临床分离菌的分布及对抗菌药物的耐药状况。方法:收集湖北地区15所三级甲等医院重症监护患者临床标本培养的致病菌1 935株,并进行纸片法药敏试验,根据2001年NCCLS颁布的准则,采用“WHONET 5”软件进行分析。结果:革兰阳性菌和革兰阴性菌分别占25.9%和74.1%。革兰阴性菌中以铜绿假单胞菌最常见(22.2%),再依次为不动杆菌、嗜麦芽窄食单胞菌和克雷伯杆菌;革兰阳性菌中,凝固酶阴性葡萄球菌多于金黄色葡萄球菌(分别为10.0%和7.8%)。药敏试验表明:铜绿假单胞菌对亚胺培南( IMP)的敏感率为62.0%,对其他所有抗菌药物的敏感率均低于60%。对不动杆菌属、克雷伯菌属和肠杆菌属敏感率较高的有IMP、美罗培南(MER),对大肠埃希菌敏感率较高的有IMP、MER和头孢吡肟,嗜麦芽窄食单胞菌仅对左氧氟沙星敏感(敏感率87.0%),对其他抗菌药物的敏感率均低于57%。结论:重症监护患者感染致病菌以革兰阴性菌为主,尤以铜绿假单胞菌常见。致病菌耐药问题严重,及时监测重症监护患者感染致病菌的变迁和耐药发展趋势以指导临床用药至关重要。

Prevalence of Pathogens and Their Resistance to Antimicrobial Agents in Intensive Care Units

Objective: To investigate the prevalence of pathogens isolated from the patients in intensive care units (ICUs) and the resistance to antimicrobial agents.Methods: All pathogens from the patients in intensive care units were collected in 15 large hospitals of Hubei Province during 2002~2003. The bacterial susceptibility test was performed by Kirby-Bauer method. The results were interpreted according to the guideline of NCCLS and analyzed by WHONET-5 software. Results:Gram positive and Gram negative bacteria accounted for 25.9% and 74.1% respectively. Pseudomonas aeruginosa was the commonest Gram(-)pathogen in ICUs ( 22.2%), followed by Acinetobacter, Stenotrophomonas maltophilia and klebsiella.Among Gram(+)bacteria coagulase negative staphylococcus was more common than Staphylococcus aureus(10% vs 7.8%). The sensitive rate of P. aeruginosa to imipenem (IMP) was 62.0%, but was lower than 60.0% to other antimicrobial agents. Acinetobacter, Klebsiella and Enterobacter were only sensitive to IMP and meropenem (MER). Escherichia coli showed high sensitivity to IMP, MER and cefepime (CFP). S.maltophilia showed better sensitivity to levofloxacia (LEV) ( 87.0%), and its sensitive rates to other agents were lower than 57%. Conclusion The predominant pathogens in intensive care units are Gram(-) bacteria, especially P. aeruginosa. The drug resistance is very significant. It is very important to monitor the changes of pathogens in the intensive care patients and the development of resistance to antimicrobial agents.