重症监护病房311株分离菌菌群分布及药敏试验结果分析

目的：调查分析安徽省铜陵市人民医院重症监护病房（ICU）分离致病菌的菌群种类特点及耐药状况,为临床合理使用抗菌药物提供参考。方法：对本院ICU 2005年1月-2007年12月送检标本中分离的311株病原菌株分布及耐药状况进行分析。结果：在311株病原菌中,有G-杆菌237株（76.21%）,G＋球菌74株（23.79%）。G-杆菌主要有鲍曼不动杆菌84株（27.01%）、铜绿假单胞菌40株（12.86%）、肺炎克雷伯菌28株（9.0%）、嗜麦芽窄食单胞菌26株（8.36%）、大肠埃希菌15株（4.82%）等,其中,产超广谱β-内酰胺酶（ESBLs）大肠埃希菌和肺炎克雷伯菌检出率分别达73.33%（11/15）和39.29%（11/28）。G＋球菌主要有凝固酶阴性葡萄球菌27株（8.68%）、肠球菌30株（9.65%）、金黄色葡萄球菌13株（4.18%）等,其中,耐甲氧西林凝固酶阴性葡萄球菌检出率达96.30%（26/27）,而耐甲氧西林金黄色葡萄球菌检出率仅为23.08%（3/13）。ICU病房感染以G-菌为主,大部分病原菌呈现高耐药和多重耐药的特点。G＋球菌对利福平、氯霉素、磷霉素、呋喃妥因仍较敏感,未见耐万古霉素和替考拉宁的G＋球菌株。结论：本院ICU病房菌群分布及耐药状况与铜陵地区医院平均水平有差异,以鲍曼不动杆菌、铜绿假单胞菌等非发酵菌最为多见。定期对ICU病房进行细菌流行病学调查和耐药分析对临床经验用药、减少新的耐药菌株出现具有指导作用。

Analysis of the distribution of 311 bacterial strains isolated from intensive care unit and their susceptibility to antibiotics

Objective： To investigate and analyze the distribution and susceptibility to antibiotics of bacterial strains isolated from intensive care unit（ICU）, in order to provide evidence for rational use of antibiotics. Methods： Three hundred and eleven bacterial strains isolated from patients in ICU were collected from January 2005 to December 2007, and the distribution and drug-resistance of the strains were investigated. Results： Of the 311 strains, 237 were gram-negative bacilli（76.21%）, including Acinetobacter baurnannii （27.01% ）, Pseudornonas aeruginosa （ 12.86 % ）, Klebsiella pneurnoniae （9, 0 % ）, Stenotrophomonas maltophilia （8.36 %）, Escherichia coli （4.82% ） and so on. The isolating rates of E. coli and K. pneumoniae producing extended spectrum β-laetamase were 73.33 % （11/15） and 39.29 % （11/28）, respectively. Seventy-four strains were grampositive cocci （23. 79 %）, including eoagulase negative Staphylococci（8.68%）, Enterococci（9. 65 %）, Staphylococcus aureus （4. 18%） and so on. The isolating rates of meticillin-resistant coagulase negative Staphylococcus and methicillin-resistant S. aureus were 96.30% （26/27） and 23.08% （3/13）, respectively. Gram-negative bacteria were the main strains isolated from ICU and most of them showed high and multi-drug resistance to antibiotics frequently used. Gram-positive cocci were still susceptible to rifampicin, chloramphenicol, fosfomyein, nitrofurantoin, vancomycin and teicoplanin. Conclusion： There is difference in bacterial distribution and those of drug-resistance between the results of this investigation and those of other hospi- tals in Tongling region. The most common strains isolated from ICU of the hospital are A. baumannii and P. aeruginosa. Periodic surveillance of bacteria distribution and resistance can guide the rational use of antibiotics in clinic and reduce the occurrence of new drug-resistant bacteria.