重症监护病房革兰阴性杆菌耐药分析

目的：调查重症监护病房（ICU）内革兰阴性杆菌的感染分布及其耐药特点,为临床合理选用抗菌药物提供依据。方法：采用纸片法或MIC法测定病原菌药物敏感性,使用WHONET 5.6软件分析我院ICU病房2010年1月至2011年1月的革兰阴性杆菌分布情况及耐药特点。结果：共分离出358株病原菌,其中革兰阴性杆菌240株（67%）,其次为革兰阳性菌和真菌,前4位病原菌为铜绿假单胞菌（35%）、鲍曼不动杆菌（23%）、肺炎克雷伯菌（14%）、大肠埃希菌（10%）。非发酵革兰阴性杆菌耐药情况严重,铜绿假单胞菌和鲍曼不动杆菌对亚胺培南耐药率分别高达47.5%和65.4%。肠杆菌科对亚胺培南及阿米卡星敏感性较高,大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶（ESBLs）试验的阳性率分别为91%和50%。结论：重症监护病房获得性感染多药耐药情况严重,尤其是非发酵革兰阴性杆菌。除了需要加强耐药性监测及优化抗菌药物使用外,还须强化感染预防控制措施。

ANALYSIS OF DRUG RESISTANCE OF GRAM-NEGATIVE BACTERIA IN INTENSIVE CARE UNIT

Objective：To investigate the distribution and drug resistance of gram-negative bacteria infection in intensive care unit（ICU） in our hospital.Methods：Disc diffusion test or MIC test was used to detect the antimicrobial sensitivity of bacteria isolates from ICU patients.WHONET 5.6 was applied to analyse the distribution of Gram-negative bacilli and drug resistance from Jan 2010 to Jan 2011.Results：A total of 358 pathogens were isolated in the survey period,including 240 Gram-negative strains,60 Gram-positive strains and 58 fungal strains.Pseudomonas aeruginosa（35%）,Acinetobacter baumannii（23%）,Klebsiella pneumoniae（14%） and Escherichia coli（10%） were the most common isolates.The drug resistance condition of non-fermenting Gram-negative bacilli was serious.The resistant rates of Pseudomonas aeruginosa and Acinetobacter baumannii to imipenem were as high as 47.5% and 65.4%.Enterobacteriaceae had high sensitivity to imipenem and amikacin.ESBLs positive rates of E.coli and Klebsiella pneumoniae were 91% and 50% respectively.Conclusion：The multi-drug resistance of pathogens was a very serious problem in our ICU,especially non-fermenting Gram-negative bacilli.In addition to strengthen antimicrobial resistance monitoring and optimization of drug use,it is necessary to strengthen infection prevention and control measures.