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目的分析重症监护室(ICU)患者感染常见病原菌的分布及耐药情况,为临床合理使用抗菌药物提供依据。方法对2013年全年ICU送检的各种标本的细菌学培养结果进行回顾性分析。结果共检出病原菌805株。其中革兰氏阴性杆菌705株(占87.6%),革兰氏阳性球菌100株(占12.4%)。而革兰氏阴性杆菌中鲍曼不动杆菌检出211株(占26.2%),且多为泛耐药菌株,其次分别为肺炎克雷伯菌183株(占22.7%)、铜绿假单胞菌122株(占15.2%)、大肠埃希氏菌90株(占11.2%)、阴沟肠杆菌34株(占4.2%)、嗜麦芽窄食单胞菌30株(占3.7%)、洋葱伯克霍尔德菌28株(占3.5%),均对头孢类抗菌药物耐药率较高,对亚胺培南、哌拉西林/他唑巴坦耐药率较低;革兰氏阳性球菌中主要为葡萄球菌属,对万古霉素、利奈唑烷、喹努普汀/达福普汀、替加环素均敏感。结论 ICU患者感染严重,病原菌以革兰氏阴性杆菌为主,其次是革兰氏阳性球菌。呈现细菌种类多、耐药率高的特点。应加强ICU感染病原菌分布及耐药性监测,合理规范使用抗菌药物,避免耐药菌在医院传播及流行。
Objective To analyze the distribution and drug resistance of common pathogens in intensive care unit (ICU) patients and provide the basis for rational use of antimicrobial agents in clinic. Methods The results of bacteriological culture of various specimens submitted by ICU in 2013 were retrospectively analyzed. Results A total of 805 pathogenic bacteria were detected. There were 705 Gram-negative bacilli (87.6%) and 100 Gram-positive cocci (12.4%). Acinetobacter baumannii in Gram-negative bacilli detected 211 strains (accounting for 26.2%), and mostly pan-resistant strains, followed by Klebsiella pneumoniae 183 strains (22.7%), Pseudomonas aeruginosa 122 strains of bacteria (15.2%), 90 strains of Escherichia coli (11.2%), 34 strains of Enterobacter cloacae (4.2%), 30 strains of Stenotrophomonas maltophilia (3.7%), 28 strains of Klebsiella (accounting for 3.5%) had higher rates of resistance to cephalosporins and lower resistance rates to imipenem and piperacillin / tazobactam; Gram-positive cocci Mainly in the genus Staphylococcus, vancomycin, linezolid, quinapristin / dalfopristin, tigecycline are sensitive. Conclusion ICU patients have serious infection, with Gram-negative bacilli as the main pathogens, followed by Gram-positive cocci. Bacterial species showed a high rate of resistance characteristics. ICU infection should be strengthened to detect the distribution of pathogens and drug resistance monitoring, rational use of antimicrobial agents, to prevent drug-resistant bacteria in the hospital spread and epidemic.