2014-2018年武汉市普仁医院重症医学科病原菌分布及耐药性分析

目的 对2014-2018年武汉市普仁医院重症医学科病原菌的分布及耐药性进行分析，为临床使用抗菌药物提供依据。方法 收集2014年1月-2018年12月武汉市普仁医院重症医学科分离的菌株，并对其进行细菌培养和药敏试验，对病原菌的分布及耐药性进行分析。结果 共分离出2 187株病原菌，革兰阴性菌1 600株，构成比73.16%，主要为肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌、铜绿假单胞菌；革兰阳性菌451株，构成比为20.62%，主要为金黄色葡萄球菌、凝固酶阴性葡萄球菌、屎肠球菌、粪肠球菌；真菌136株，构成比为6.22%，主要为白色念珠菌、光滑念珠菌、热带念珠菌。肺炎克雷伯菌对所监测抗菌药物的耐药率均小于为25.0%，大肠埃希菌对哌拉西林、头孢唑啉、头孢噻肟、头孢曲松、头孢呋辛、环丙沙星、左氧氟沙星的耐药率大于40.0%，鲍曼不动杆菌除对头孢哌酮/舒巴坦、氨苄西林/舒巴坦、阿米卡星的耐药率小于33%之外，对其他监测抗菌药物的耐药率均大于58.0%，铜绿假单胞菌对所监测抗菌药物的耐药率小于15.0%，金黄色葡萄球菌对青霉素类抗菌药物的耐药率大于95.0%，对克林霉素、阿奇霉素、红霉素的耐药率达50.0%左右，未发现耐万古霉素的金黄色葡萄球菌。凝固酶阴性葡萄球菌对青霉素G的耐药率大于92.0%；发现1株耐万古霉素的屎肠球菌，未发现耐万古霉素、替考拉宁、利奈唑胺和替加环素耐药的葡萄球菌和粪肠球菌。念珠菌属对伏立康唑的耐药率大于20.0%，对其他所监测抗菌药物均较敏感。结论 武汉市普仁医院重症医学科病原菌分布广泛、耐药率高，应加强病原菌耐药性的监测，为临床医生合理应用抗菌药物提供依据。

Analysis on distribution and drug resistance of pathogenic bacteria in Intensive Care Unit of Wuhan Puren Hospital from 2014 to 2018

Objective To analyze the distribution and drug resistance of pathogenic bacteria in Intensive Care Unit of Wuhan Puren Hospital from 2014 to 2018, in order to further provide the reference for rational use of antibacterial agents. Methods The strains were isolated from Intensive Care Unit of Wuhan Puren Hospital from January 2014 to December 2018, and bacterial culture and drug susceptibility test were carried out to analyze the distribution and drug resistance of pathogenic bacteria. Results A total of 2 187 strains of pathogenic bacteria were isolated, of which 1 600 strains were Gram-negative bacilli, with a composition ratio of 73.16%, including Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii, and Pseudomonas aeruginosa. There were 451 stains of Gram-positive bacteria with a composition ratio of 20.62%, mainly including Staphylococcus aureus, coagulase negative Staphylococcus, Enterococcus faecium, and Enterococcus faecalis. Fungi were 136 strains, accounting for 6.22%, mainly including Candida albicans, Candida glabrata, and Candida tropicalis. The drug resistance rate of K. pneumoniae against antibacterial drugs were lower than 25.0%. The drug resistance rate of E. coli against piperacillin, cefazolin, cefotaxime, ceftriaxone, cefuroxime, ciprofloxacin, and levofloxacin were more than 40.0%. The drug resistance rate of A. baumannii against cefoperazone/sulbactam, ampicillin/sulbactam and amikacin were lower than 33%, while the drug resistance rate against other antibacterial drugs were more than 58.0%. The resistance rate of P. aeruginosa against monitored antibiotics were less than 15.0%. The resistance rate of S. aureus against penicillin antibiotics were more than 95.0%, and the resistance rate against clindamycin, azithromycin, and erythromycin were about 50%. Ther was no S. aureus resistant to vancomycin. The resistance rate of coagulase negative Staphylococcus against penicillin G was more than 92.0%. There was only 1 strain of E. faecalis resistant to vancomycin. Ther was no Staphylococcus resistant to vancomycin, teicoplanin, linezolid, and tigecycline. The resistance rate of Candida against voriconazole was higher than 20.0%, while was sensitive to other antibacterial drugs. Conclusion The pathogenic bacteria in Intensive Care Unit of Wuhan Puren Hospital are widely distributed and have high drug resistance rate. Monitoring of drug resistance of pathogenic bacteria should be strengthened to provide basis for clinicians to reasonably apply antibacterial drugs.