目的 研究探讨重症监护病房(ICU)病原菌的分布及耐药情况,为临床合理使用抗菌药物提供科学依据。方法 回顾性分析2015年ICU住院患者送检细菌分离培养及药敏试验结果。结果 ICU共送检标本1 326份,分离出病原菌554株,其中革兰阴性病原菌462株(83.4%),革兰阳性病原菌48株(8.7%),真菌44株(7.9%)。革兰阴性杆菌前5位依次为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、粘质沙雷菌和大肠埃希菌,且多耐药菌株比例较高。革兰阳性病原菌以金黄色葡萄球菌为主,32株(66.7%),MRSA检出率78.3%(25/32)。结论 加强重症监护病房的细菌及药敏监测,根据病原菌药敏结果指导临床合理使用抗菌药物,控制耐药菌株的产生,预防及控制院内感染及感染暴发。

Objective To investigate the distribution characteristics and drug resistance of pathogenic bacteria in intensive care unit(ICU) and provide scientific evidence for clinically reasonable use of antibiotics. Methods Specimens from hospitalized intensive care unit patients in 2015 were obtained for routine bacterial isolation and culture. Results A total of 554 bacterial strains were isolated from 1326 specimens, in which Gram-negative bacilli accounted for 462 stains (83.4%),Gram-positive cocci accounted for 48 stains (8.7%),and fungi accounted for 44 stains (7.9%). Gram-negative bacilli of the top five were Acinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumoniae, Serratia marcescens and Escherichia coli,and the rate of multiple resistant bacteria was relatively high.Staphylococcus aureus were the main Gram-positive cocci, including MRSA accounted for 78.3%(25/32). Conclusion The monitoring of ICU clinical pathogens and their resistance should be strengthened. It is a great significance to use antibiotics rationally according to the results of susceptibility testing, in order to control the occurrence of resistant bacteria , prevent and control hospital infection and infection outbreak.

目的 调查重症监护病房(ICU)医院感染的常见细菌分布及耐药性变化,为合理使用抗生素和医院感染的预防控制提供相关科学依据。方法 回顾性分析医院2007—2011年ICU收治的381医院感染患者感染菌株分布特点及耐药性情况。结果 ICU医院感染常见菌株主要来源于痰液标本,占78.2%,其次是血液。381 株临床分离菌中共检出革兰阴性杆菌262 株、革兰氏阳性球菌70例和真菌49例,分别占68. 8%、24.9%和占17.4%。革兰阴性杆菌中鲍氏不动杆菌(24.7%)、肺炎克雷伯氏杆菌(10.8%)、铜绿假单胞菌(9.2%)排前三位。其中除碳青霉烯类药物及抑酶制剂,鲍氏不动杆菌对其余抗菌药物耐药率均＞40%。革兰氏阳性球菌以金黄色葡萄球菌为主。对青霉素、庆大霉素、红霉素的耐药率均＞50%。结论 呼吸道仍是ICU最常见的感染部位。病原菌以革兰阴性杆菌为主,且对常用抗菌药物的耐药率逐渐升高,临床应加强抗菌药物规范使用,避免耐药菌株的产生。

Objective To investigate the distribution and drug resistance of pathogens in intensive care unit(ICU)causing nosocomial infections so as to provide scientific basis for antibiotic adoption and the prevention and control of nosocomial infections. Methods The specimen sources and the clinical distribution of the 381 pathogens isolated from 2007 to 2011 were retrospectively analyzed. The drug resistance was observed in ICU that causing nosocomial infections. Results The sputum was the major specimens source in ICU, accounting for 78.2%. Of the 381 pathogens causing nosocomial infections in ICU, the 262 gram-negative bacilli (68.8%), 70 gram-positive cocci (24.9%),and 49 fungi (17.4) were isolated, Among gram-negative bacilli the top three were acinetobacter baumannii (24.7%), klebsiella pneumonia(10.8%),and pseudomonas aeruginosa (9.2%). The drug resisitance rate of baumannii to antibiotics were more than 40%,beside carbapenem and B-Lactamaseinhibitors. The main gram-positive cocci of causing nosocomial infections was saphylococcus aureus in ICU. The drug resisitance rate of S. aureus to penicillin, erythromycin and gentamicin were higher than 50.0%. Conclusion The main distribution area of nosocomial infections was the respiratory tract and the gram-negative bacilli were the common pathogens in ICU. It was benefit to avoid presenting of drug resistant strain, and antibiotics should be reasonably used in clinic.