2015—2017年武汉市中心医院重症监护室感染性疾病病原菌分布及耐药性分析

目的 了解武汉市中心医院重症监护室感染性疾病病原菌的分布及耐药性，为临床合理使用抗菌药物提供依据。方法 回顾性分析2015年1月-2017年12月武汉市中心医院重症监护室的病原菌分布及药敏结果。结果 共分离得到8 356株病原菌，其中革兰阴性菌4 520株，占比54.09%，以大肠埃希菌（15.94%）、鲍曼不动杆菌（12.79%）、肺炎克雷伯菌（9.12%）为主；革兰阳性菌3 011株，占比36.03%，以金黄色葡萄球菌（10.60%）、肺炎链球菌（7.59%）、凝固酶阴性葡萄球菌（4.15%）为主；真菌825株，占比9.87%，主要为白假丝酵母（4.56%）；大肠埃希菌对头孢吡肟、头孢他啶、头孢噻肟、庆大霉素、环丙沙星、复方新诺、阿莫西林/棒酸具有高耐药性，耐药率均高于40%，对头孢噻肟、复方新诺明的耐药率在60%以上。鲍曼不动杆菌除对多黏菌素E敏感外，对其他被检药物的耐药率处于较高水平。肺炎克雷伯菌除对多黏菌素E、庆大霉素和左氧氟沙星较敏感外，对其余抗菌药物均有较高耐药率；金黄色葡萄球菌和肺炎链球菌对万古霉素、头孢唑林及左氧氟沙星有较低耐药率，对其余抗菌药物均有较高耐药率。凝固酶阴性葡萄球菌对万古霉素、利福平及左氧氟沙星敏感。白假丝酵母对5-氟胞嘧啶、氟康唑、伏力康唑、伊曲康唑有较低耐药率，而热带假丝酵母只对5-氟胞嘧啶耐药率较低。结论 武汉市中心医院重症监护室感染的主要病原菌多为条件致病菌，但耐药情况严重，应定期统计分析本院病原菌耐药情况，为医生合理使用抗菌药物提供依据。

Analysis on the distribution and drug resistance of pathogenic bacteria of infectious diseases in Intensive Care Unit of Wuhan Central Hospital from 2015 to 2017

Objective To understand the distribution and drug resistance of pathogenic bacteria of infectious diseases in Intensive Care Unit of Wuhan Central Hospital, and provide evidence for the rational use of antibiotics in clinical practice. Methods A retrospective analysis was conducted on the distribution of pathogens and drug susceptibility results in Intensive Care Unit of Wuhan Central Hospital from January 2015 to December 2017. Results A total of 8 356 strains of pathogens were isolated, among which 4 520 were Gram-negative bacteria, accounting for 54.09%, and main of them were Escherichia coli (15.94%), Acinetobacter baumannii (12.79%), and Klebsiella pneumoniae (9.12%). Gram-positive bacteria (3 011strains) accounted for 36.03%, and main of them were Staphylococcus aureus (10.60%), Streptococcus pneumoniae (7.59%), and coagulase-negative Staphylococcus (4.15%). Fungi were 825 strains (9.87%), and main of them were Candida albicans. E. coli had high resistance rates against cefepime, ceftazidime, cefotaxime, gentamicin, ciprofloxacin, trimethoprim/sulfamethoxazole, amoxicillin/clavulanic acid, and the drug resistance rate was higher than 40%, and the resistance rate against cefotaxime and trimethoprim/sulfamethoxazole was more than 60%. A. baumannii was sensitive to polymismin E, while the resistance rate against the other drugs was at a high level. K. pneumoniae was more sensitive to polymyxin E, gentamicin, and levofloxacin, while K. pneumoniae had high resistance rates against other drugs. The resistance rate of S. aureus and S. pneumoniae against vancomycin, ceftriaxone, and levofloxacin was low, while the resistance rate against the other drugs was at a high level. Coagulase-negative S. had high sensitive rates against vancomycin, rifampicin and levofloxacin. C. albicans had lower resistance rates against 5-fluorocytosine, fluconazole, voriconazole, and itraconazole, while C. tropicalis only had lower resistance rates against 5-fluorocytosine. Conclusion The main pathogens of nosocomial infection are mostly pathogenic bacteria in Intensive Care Unit of Wuhan Central Hospital, but the drug resistance is serious. Statistical analysis should be conducted on the drug resistance of the pathogens, so as to provide a basis for physician to use antibiotics rationally.