2014-2016年北京丰台医院ICU感染的病原菌分布及耐药性分析

目的 探究北京丰台医院ICU患者感染病原菌的分布及耐药性情况,以指导抗菌药物的使用.方法 收集2014—2016年北京丰台医院ICU患者的各类标本,对ICU患者感染病原菌的分布及耐药性情况进行统计分析.结果 共分离出4311株病原菌,其中革兰阴性菌2161株,占50.1%,以大肠埃希菌、鲍曼不动杆菌、铜绿假单胞菌为主;革兰阳性菌1548株,占35.9%,以金黄色葡萄球菌、肺炎链球菌和溶血葡萄球菌为主;真菌602株,占14.0%,以白假丝酵母、热带假丝酵母、光滑假丝酵母为主.大肠埃希菌和铜绿假单胞菌对多黏菌素E、亚胺培南、阿米卡星、美罗培南、哌拉西林和头孢哌酮等头孢菌素和青霉素类药物都保持较高敏感性.而鲍曼不动杆菌耐药性较强,仅对多黏菌素E保持较高敏感性;主要革兰阳性菌均对万古霉素和替考拉宁有较好的敏感性,而对青霉素和红霉素等药物耐药性较强;主要真菌对氟康唑、5-氟胞嘧啶、两性霉素B、伏力康唑、伊曲康唑均有较好敏感性.结论 北京丰台医院ICU患者感染病原菌以革兰阴性菌为主,合理应用抗菌药物是延缓病原菌耐药性、控制医源性感染的重要方法.

Analysis on distribution and drug resistance of pathogenic bacteria in ICU of Beijing Fengtai Hospital from 2014 to 2016

Objective To explore the distribution and drug resistance of pathogenic bacteria in ICU of Beijing Fengtai Hospital, in order to guide the use of antimicrobial agents. Methods The samples of ICU patients in Beijing Fengtai Hospital from 2014 to 2016 were collected, and the distribution and drug resistance of pathogenic bacteria of ICU patients were analyzed retrospectively. Results Total 4 311 strains of pathogens were isolated, in which Gram-negative bacteria were 2 161 strains (50.1%), and main of them were Escherichia coli, Acinetobacter baumannii, and Pseudomonas aeruginosa. Gram-positive bacteria (1 548 strains) accounted for 35.9%, and main of them were Staphylococcus aureus, Streptococcus pneumoniae, and Staphylococcus haemolyticus. Fungi were 602 strains (14.0%), and main of them were Candida albicans, C. tropicalis, and C. glabrata. E. coli and P. aeruginosa were highly sensitive to cephalosporins and penicillins such as polymyxin E, imipenem, amikacin, meropenem, piperacillin, and cefoperazone. While the resistance of A. baumannii was strong, and only maintain a high sensitivity to polymyxin E. Main Gram-positive bacteria were sensitive to vancomycin and teicoplanin, while the drug resistance against penicillin and erythromycin were strong. Main fungi were sensitive to fluconazole, 5-fluorocytosine, amphotericin B, viconazole, and itraconazole. Conclusion The main pathogens in ICU of Beijing Fengtai Hospital is still Gram-negative bacteria. The rational application of clinical antimicrobial drugs is an important method to delay the drug resistance of pathogens and to control iatrogenic infection.