内科ICU和呼吸科病房临床分离菌的变迁及耐药性监测研究

目的研究我院内科ICU和呼吸科病房临床分离细菌的分布和细菌耐药性变迁。方法收集2002～2006年我院内科ICU和呼吸科病房送检的所有标本的细菌培养和药物敏感试验结果。结果共收集分离菌753株,以革兰氏阴性菌为主。肺炎链球菌对青霉素的耐药率为33%～67.8%,对左氧氟沙星的耐药率为26.3%～30.1%;肠杆菌科细菌和鲍曼不动杆菌对亚胺培南高度敏感;金葡菌中MRSA达74.5%,5年中呈增加趋势;未发现耐万古霉素的金葡菌和肠球菌。产ESBL大肠埃希菌株分离率为32.4%～36.8%,肺炎克雷伯菌为15.7%～18.3%;2006年铜绿假单胞菌敏感率在60%以上的药物依次为头孢他啶89%、阿米卡星84.3%、左氧氟沙星68.2%、亚胺培南69.3%、哌拉西林他唑巴坦70.3%、头孢吡肟67.7%。结论我院内科ICU和呼吸科病房临床分离菌及细菌耐药性的变迁符合国内细菌耐药性变化的总体趋势,与患者基础疾病、病情严重程度和用药史等因素有关,对抗菌药物的选用具有指导意义。

CHANGES OF PATHOGENS AND ANTIBIOTIC SUSCEPTIBILITY SURVEILLANCE IN MICU AND RESPIRATORY WARD

Objective To explore the changes of pathogens and antibiotic susceptibility in ICU and a respiratory.ward.Methods All pathogens isolated from patients in ICU and a respiratory ward from 2002 to 2006 and the drug susceptibility result were retrospectively analyed.Results A total of 753 strains were analyzed.The majority was gram negative bacteria.MRSA prevalence was 74.5% and showed a trend of increase.No Vancomycin resistant.Staphylococcus aureus or Enterococcus was detected.Streptococcus Pneumoniae was highlg resistant to macrolides.The non-sensitivity rate to Penicillin was 33%~67.8%over gears.The resistance rate to levofloxacin was 26.3%~30.1%.Enterobacter and Acinetobacter baumannii showed stable susceptibility to imipenem.ESBLs-producing Escherichia Coli and Kledsiella Pneumoniae accounted for 32.4%~36.8%and 15.7%~18.3%respectively.Pseudomonas aeruginosa strains were relatively susceptible to ceftazidime,amikacin,levofloxacin,imipenem,piperacillin-tazobactan and cefepime.The sensitivity rate was 89%,84.3%,68.2%,69.3%,70.3%,and67.7%.Conclusion The changes of pathogens and antibiotic resistance in ICU and a respiratory ward were consistent with the surveillance data in this country,which were influencel by underlying diseases.severity of illness and antibiotic use.Our datd are useful for the guidance of rational use of antibiotics.