刘新明,管青.一所教学医院重症监护病房病原及其耐药性分析[J].内科急危重症杂志,2015,21(1):
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| DOI： |
| 中文关键词: ICU 耐药性监测 抗菌药物 |
| 英文关键词:intensive care unit resistance surveillance antimicrobial agent |
| 基金项目:流程管理 |
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| 中文摘要: |
| 目的 了解2013年某教学医院重症监护病房（ICU）患者感染常见病原菌的分布及对抗菌药物的耐药性。方法 收集2013年某教学医院ICU患者临床分离的1379株非重复细菌，进行分析。 结果 共分离病原菌1379株，革兰阴性菌827株占60%，革兰阳性菌461株占33.4%，真菌91株占6.6%。最常见的菌种分别为鲍曼不动杆菌（26.4%）、金黄色葡萄球菌（17.8%）、铜绿假单胞菌（11.2%）、凝固酶阴性葡萄球菌（CNS，7.5%）、肺炎克雷伯菌（6%）、大肠埃希菌（5.7%）嗜麦芽窄食单胞菌（5.5%）和屎肠球菌（3.1%）。耐甲氧西林金葡菌（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）的检出率分别为88.4%和88.3%，未发现对万古霉素、替考拉宁和利奈唑胺不敏感的葡萄球菌。粪肠球菌对所测抗菌药物的耐药率均明显低于屎肠球菌。检出2株耐万古霉素的屎肠球菌（VRE），未发现对替考拉宁和利奈唑胺耐药的肠球菌。大肠埃希菌和肺炎克雷菌产ESBLs检出率分别为70%和36%。产ESBLs菌株对测试药物的耐药率明显高于非产ESBLs菌株。肠杆菌科细菌中发现1株耐碳氢酶烯类的肺炎克雷伯菌。铜绿假单胞菌对亚胺培南和美洛培南的耐药率分别为62.3%和60.4%，对其他测试药物的耐药率也都在42.9%以上。鲍曼不动杆菌对上述2种碳青霉烯类抗菌药物的耐药性分别为93.7%和94.2%，泛耐药鲍曼不动杆菌的检出率达到47.5%。真菌以白念珠菌为主，对5种抗真菌药物耐药率均小于5.9%。分离细菌的标本来源主要是痰液（58%），其次是血液（16%）、引流液（10%）、尿液（7%），以及胸水、腹水等。 结论 该教学医院ICU分离的细菌耐药现象严重，特别是多耐药革兰阴性杆菌，应加强病原学和耐药性监测，为临床合理应用抗菌药物和预防医院感染提供一定的参考依据。 |
| 英文摘要: |
| Objective To investigate the distribution and antibacterial resistance in clinical strains isolated from Intensive Care Unit (ICU) of one teaching Hospital in 2013. Method Collect and analyze the 1379 non-respective clinical strains isolated from ICU patients of one teaching hospital in 2013. Results A total of 1379 strains were isolated, including gram-negative bacteria (827, 60%), gram-positive bacteria (461, 33.4%) and fungi (91, 6.6%). The most comman strains were Acinetobacter baumannii (26.4%), Staphylococcus aureus (17.8%), Pseudomonas aeruginosa (11.2%), coagulase-negative Staphylococcus (CNS, 7.5%), Klebsiella pneumoniae (6%), Escherichia coli (5.7%) and Stenotrophomonas maltophilia (5.5.%) and Enterococcus faecium (3.1%). The prevalence of MRSA and MRCNS were 88.4% and 88.3%, respectively. No staphylococcal strains were found resistant to vancomycin, teicoplanin or linezolid. The resistance rates of E. faecalis strains to most tested drugs were much lower than those of E. faecium. Two strain of E. faecium were resistant to vancomycin. No strains of enterococcus resistant to teicoplanin or linezolid were detected. ESBLs-producing Enterobacteriaceae strains were most resistant than non-ESBLs-producing strains in terms of antibiotic resistance rates. Beta-lactamase was produced in 70% of E. coli and 36% of K. pneumoniaec. One strain of carbapenem-resistant K. pneumoniaec was detected. The resistance rate of P. Aeruginosa strains to imipenem and meropenem were 62.3% and 60.4% and was over 42.9% to other antibiotics. The resistance rate of A. Baumannii strains to imipenem and meropenem were 93.7% and 94.2% repectively. The rate of pan-resistant A. baumannii was over 47.5%. The fungi was main Candida albicans and the resistant rate to the five anti-fungal agents were less than 5.9%. The trains were mainly isolated from sputum (58%), blood (16%), drainage (10%), urine (7%), abodominal fluid and pleural fluid. Conclusion The phenomenon of multi-drug resistance was serious, especially in gram-negative bacteria. Continuous monitor of distribution and drug-resistance profiles of pathogens in ICU could provide evidence for the control of nosocomial infection and anti-infection therapy． |
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