外科重症监护病房中常见病原菌分布和耐药性监测

目的 分析上海交通大学医学院附属新华医院外科重症监护病房（SICU）中常见病原菌分布及其耐药特征.方法 收集123例SICU患者各种病原学标本,分析常见病原菌分布情况并进行药敏监测.结果 共分离出497株病原菌,其中革兰阴性菌占58.1%,其次为革兰阳性菌（19.7%）和真菌（22.1%）.真菌以白色假丝酵母菌（15.1%）为主.痰液标本的病原体分离率较高（278株）,病原菌分布从高到低依次为鲍曼不动杆菌（20.5%）、铜绿假单胞菌（20.5%）、白色假丝酵母菌（15.8%）和大肠埃希菌（7.9%）.鲍曼不动杆菌对头孢哌酮/舒巴坦耐药率最低（21.0%）.大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶（ESBLs）试验的阳性率分别为49.3%和40.9%,对亚胺培南高度敏感.革兰阳性菌对万古霉素和利奈唑胺敏感性最高.结论 加强SICU病原菌流行病学监测对合理使用抗菌药物,减少耐药菌株的产生有重要临床指导价值.

Distribution and antibacterial resistance of pathogens in surgical intensive care unit

Objective To analyse the distribution and antibacterial resistance of pathogens in Surgical Intensive Care Unit ( SICU) of Xinhua Hospital, School of Medicine, Shanghai Jiaotong University. Methods The pathogenic specimens of 123 patients hospitalized in SICU were collected, and all the specimens were analysed for pathogen distribution and resistance to antibiotics. Results A total of 497 strains of pathogenic bacteria were isolated, and Gram-negative bacteria were the most popular pathogens (58. 1%), whereas Gram-positive bacteria and fungi accounted for 19.7% and 22. 1%, respectively. The most common fungus was Candida albicans (15. 1%). Most pathogens were separated from lower respiratory tract (278 strains). The four most common pathogens in all the specimens were Acinetobacter baumannii (20.5%), Pseudomonas aeruginosa (20.5%), Candida albicans (15.8%) and Escherichia Coli (7.9%). Acinetobacter baumannii showed the lowest resistance to cefoperazone-sulbactam (21.0%). The positive rates of the extended spectrum β-lactamases (ESBLs)-producing strains of Escherichia coli and Klebsiella pneumoniae were 49. 3% and 40. 9%, and there was high sensitivity to imipenem. Cram-positive bacteria were most sensitive to vancomycin and linezolid. Conclusion Epidemiological investigation of pathogens in SICU is of great importance to the rational use of antibiotics and may help to reduce the emergence of resistant strains.