综合性重症监护病房内感染患者病原菌的分布及其耐药性分析

Surveillances of pathogens distribution and antibiotic resistance in general intensive care unit

关键词:  重症监护病房  感染  药物敏感试验  细菌耐药性

Key words:  intensive care unit  infection  bacterial susceptibility testing  bacterial resistance

摘要:

探讨综合性重症监护病房（ICU）中感染的病原菌分布及药物敏感试验情况，为临床经验性选择抗生素提供必要的细菌学依据。［方法］收集2001年4月～2002年7月入住ICU患者的痰、血、尿、脑脊液、中心静脉穿刺针顶 端及局部引流物进行细菌学培养及药物敏感性试验。［结果］ 94例患者中68例至少有一个 部位分离出病原菌，共分离出病原菌487株，分离的部位以下呼吸道为主，其次为泌尿系，继之为血液，且多为两个部位以上。在487株分离的菌株中，G－杆菌280株，其次为G+球菌，第三是真菌。产超广谱β-内酰胺酶（ESBL）细菌集中于产气肠杆菌、肺炎克雷伯菌、阴沟肠杆菌和大肠埃希菌。亚胺培南对G－杆菌的敏感性较好，但产ESBL大肠埃希菌、铜绿假单胞菌、醋酸钙不动杆菌及洋葱假单胞菌对其的耐药率均较高；产ESBL菌对第三代头孢菌素的耐药性较高。另外，G+球菌的感染率呈上升趋势，万古霉素及四环素对其的敏感性较好，但已有耐万古霉素的肠球菌及葡萄球菌产生。［结论］ ICU内感染的病原菌主要存在于呼吸道，病原菌以G－杆菌为主，病原菌显示多重耐药。亚胺培南对G－杆菌敏感性较好，而万古霉素对G＋球菌有较高的敏感性

Abstract:

To investigate the distribution of pathogens and their Xantibiotic susceptibility in general intensive care unit.［Methods］ Pathogens isolated in sputum, blood, urine, cerebrospinal fluid, central venous catheter and local drain from patients admitted were collected and analyzed during April 2001 to July 2002. ［Results］ A total of 487 pathogens were identified, pathogens were isolated from at least one location in 68 cases out of 94 patients. The most common sites of infection were lower respiratory tract, followed by urinary tract and blood system. Among 487 strains,57.5% were Gram-negative bacteria,22.8% were Gram positive cocci and 19.7% were fungi.Extened-spectrum β-lactamases-producing strains were identified in Enterobacter aerogene, Klebsiella pneumoniae, Enterobacter cloacae and Escherichia coli. Most of Gram negative bacteria were sensitive to imipenem, but the resistance rates of Steno maltophilia and Pseudomonas cepacia were higher, ESBLS-producing strains were more resistant to the third-generation cephalosporins. Furthermore, trend of coli infection are increasing, Vancomycin and Tetracycline were most active, but Vancomycin resistant enterococci and staphylococcus were detected in this study.［Conclusions］ Lower respiratory tract are the major infection site in intensive care unit, Gram-negative bacilli are the most common pathogens,which present with multi-drug resistant pattern. Most of Gram negative bacteria are sensitive to imipenem，Vancomycin is active against Gram positive cocci