我院2009—2011年重症监护病房病原菌分布及耐药性分析

目的调查我院重症监护室（ICU）病原菌的感染分布情况与耐药变迁,以指导医院感染病原菌的耐药性监测和临床合理使用抗生素。方法对2009年1月—2011年12月ICU住院患者各类感染性标本分离的4116株病原菌（2009年,1137株;2010年,1413株;2011年,1566株）资料进行回顾性分析。结果鲍曼不动杆菌2009年检出率位居第二,后两年则稳居榜首;铜绿假单胞菌从前两年并列第二,降至2010年的第三位14.8%稍有回落;大肠杆菌检出率2009—2011年依次为6.3%、7.7%和7.8%,呈逐年上升趋势;屎肠球菌2009年的检出率为3.3%,2010年为4.5%,2011年为4.5%。头孢派酮/舒巴坦对G-杆菌有较好的敏感性;头孢吡肟对铜绿假单胞菌的耐药率在20%左右;多粘菌素B有很好的敏感性,2011年未发现耐药菌株;碳青酶烯类抗生素对肺炎克雷伯菌的敏感率100%;哌拉西林/他唑巴坦的耐药率2009年为28.5%,2010年为23.7%,2011年为14.9%;米诺环素对屎肠球菌的耐药率逐年下降,2009年为13.2%,2010年为12.7%,2011年为4.3%。耐甲氧西林的金黄色葡萄球菌的检出：2009年为89.0%、2010年为90.5%、2011年为92.3%,呈现逐年升高趋势,但未发现对万古霉素、替考拉宁、利那唑胺耐药菌株。结论 ICU病房病原菌检出率高,且常为条件致病菌和多重耐药菌,耐抗菌药物种类广,耐药性强。临床应高度重视耐药菌的监测,合理使用抗生素。

Pathogenic Bacterial Distribution and Drug Resistance Changes in A General Hhospital of Intensive Care Unit from 2009 to 2011

Objective To investigate the detection of infectious pathogens and their drug resistance in a general hospital of intensive care unit（ICU）,and to provide guidance for monitoring drug resistance of nosocomial infection pathogens and rational use of antibiotics.Methods A total of 4116 strains of pathogens in various infections samples of intensive care unit（ICU） from Jan 2009 to Dec 2011 were retrospectively analyzed.Results The detectable rate of Acinetobacter baumannii ranked the second in 2009,and the first in the following 2 years;while that of Pseudomonas aeruginosa ranked the second in the first two years,but fell to the third position with 14.8% in 2010,a slight drop.The detection rate of Escherichia coli was 4.8% in 2009,7.7% in 2010 and 7.8% in 2011.The detection rate of Enterococcus faecium was 3.3% in 2009,4.5% in 2010 and 74.5% in 2011.Gram-negative bacteria were highly sensitive to cefoperazone /sulbactam;The resistant rate of Pseudomonas aeruginosa to Cefepime was about 20%;Polymyxin B has a good sensitivity and we found no resistant strains in 2011;The sensitive rate of Klebsiella pneumoniae to carbapenem an tibiotics was 100%.The resistant rate of Piperacillin/tazobactam was 28.5% in 2009,23.7% in 2010,14.9% in 2011;The resistant rate of Enterococcus faecium to Minocycline was 13.2% in 2009,12.7% in 2010,4.3% in 2011.The detection rate of MRSA was 89% in 2009,90.5% in 2010 and 92.3% in 2011,but no strains being resistant to van comycin,teicoplanin and linezolid had been detected.Conclusion The bacteria isolation rate in ICU wag high,and most of them were conditional pathogenic bacteria and multi-drug resistant bacteria.It is necessary to strengthen the surveillance of drug resistant strains and use antibiotics rationally.