我院2010年7月-2013年6月ICU革兰阴性杆菌分布及耐药性分析

目的:了解我院重症监护病房(ICU)革兰阴性(G-)杆菌的分布及耐药情况,为临床合理、规范地使用抗菌药物提供参考。方法:采用WHONET 5.4软件,对我院2010年7月-2013年6月ICU患者送检标本中分离的593株G-杆菌的分布及耐药状况进行回顾性分析。结果:我院ICU分离率最高的G-杆菌依次是鲍曼不动杆菌(189株,占31.9%)、肺炎克雷伯菌(125株,占21.1%)、大肠埃希菌(77株,占13.0%)、铜绿假单胞菌(60株,占10.1%)。593株G-杆菌对常用抗菌药物均表现出不同程度的耐药性,耐药率较低的是亚胺培南、哌拉西林/他唑巴坦和阿米卡星。对亚胺培南、哌拉西林/他唑巴坦、阿米卡星,鲍曼不动杆菌的耐药率分别为70.9%、87.3%、84.1%,铜绿假单胞菌的耐药率分别为36.7%、35.0%、25.0%,肺炎克雷伯菌的耐药率分别为8.0%、21.6%、13.6%,大肠埃希菌的耐药率分别为5.2%、11.7%、10.4%。结论:我院ICU住院患者G-杆菌的耐药性较严重,耐药率较低的只有亚胺培南、哌拉西林/他唑巴坦和阿米卡星,临床医师应尽量以药敏试验结果为参考合理选用抗菌药物。

Distribution and Drug Resistance of Gram-negative Bacilli in Our Hospital from Jul. 2010 to Jun. 2013

OBJECTIVE： To understand the distribution and drug resistance of Gram-negative （G-） bacilli in intensive care unit （ICU）, and to provide reference for rational and standard use of antibiotics in the clinic. METHODS： Using WHONET 5.4 software, the distribution and drug resistance of 593 G- bacilli strains isolated from ICU patients during Jul. 2010 to Jun. 2013 were analyzed retrospectively. RESULTS： In our hospital, the G- bacilli with highest isolation rates in the ICU were Acinetobacter baumannii （189 strains, 31.9% ）, Klebsiella pneumoniae （125 strains, 21.1% ）, Escherichia coli （77 strains, 13.0% ） and Pseudo- monas aeruginosa （60 strains, 10.1% ）. 593 strains of G- bacilli showed different degrees of drug resistance to the commonly used antibiotics, and showed the lower drug resistance rates to imipenem, piperacillin/tazobactam and amikacin to imipenem, piperacil- lin/tazobactam, amikacin, the resistance rates of A. baumannii were 70.9 %, 87.3 %, 84.1% ; the resistance rates of P aeruginosa were 36.7%, 35.0% and 25.0% ; the resistance rates ofK. pneumoniae were 8.0%, 21.6%, 13.6% ; the resistance rates ofE. coli were 5.2%, 11.7% and 10.4%. CONCLUSIONS： Drug resistance of G- bacilli in ICU inpatients is serious, only imipenem, piper- acillin / tazobactam and amikacin show lower drug resistance. Clinicians should try best to use antibiotics according to the result of drug sensitivity test.