重症监护中心患者感染病原菌及耐药谱分析

目的探讨某院重症监护中心(ICU)患者感染病原菌种类、对常用抗菌药物耐药谱等,为临床和医院感染科管理提供第一手资料。方法采用K-B法对28种常用抗菌药物进行耐药率测定、纸片扩散初筛和确证试验检测ESBLs、并进行MRSA、MRCNS和VRE测定。结果在201份阳性标本中共培养出264株菌,其中G-杆菌192株,占72.7%,主要为PAE、ABA、KPN、ECO和SMA;G 菌43株,占16.3%,主要为EC、SAU和CNS;真菌29株,占11.0%,主要为白色念珠菌;病原菌抗药性强,G-杆菌对IPM、AZT、CAZ、FEP、CFS、AMK、CIP不同程度敏感,G 菌对VAN、SXT、RIF、NIF不同程度敏感;KPN、ECO的ESBLs为64.7%和64.3%、MRSA80.0%、MRCNS 66.7%、VRE 22.2%。结论ICU患者感染病原菌以G-杆菌为主,提示临床医生提高标本送检率,控制抗菌药物滥用,降低细菌耐药性,提高治愈率。

Pathogens and Drug Resistance in Intensive Care Unit Patients

OBJECTIVE To investigate the bacterial distribution and the extent of drug resistance in ICU patients,and offer the first-hand information to the clinical preventive and therapeutic countermeasures. METHODS The antimicrobial susceptibility tests to 28 commonly used antibiotics were performed using the ATB Expression of Bio-Merieux with K-B method.The ESBLs were detected by the disk diffusion tests and the confirmatory tests,and the MRSA,MRCNS,and VRE were also tested at the sametime. RESULTS Totally 264 strains were isolated from the 201 positive samples,among them 192 strains were Gram-negative bacteria,43 strains were Gram-positive ones,and 29 strains were fungi.The percentage of these three groups were 72.7%,16.3% and 11.0%,respectively.The main strains of the Gram-negative bacteria were PAE,ABA,KPN,ECO and SMA,and of the Gram-positive bacteria were EC,SAU and CNS.The major strain of fungi was C.albicans.The pathogens tested showed high drug resistance.The Gram-negative bacteria showed tendency of sensitivity to IPM,AZT,CAZ,FEP,SFC,AMK and CIP,and the Gram-positive bacteria to VAN,SXT,RIF and NIF.For KPN and ECO,the percentage of strains producing ESBLs were 64.7% and 64.3%.And the percentage of MRSA,MRCNS,VRE were 80%,66.7% and 22.2%,respectively. CONCLUSIONS It was showed that the major pathogens infected the ICU patients are Gram-negative bacteria,and the pathogens show the high drug resistance.Doctors should pay more attention to analyze the bacterial resistance profile in order to decrease the incidence of drug resistance and use the antibiotics properly.