县级综合医院ICU患者感染病原菌耐药性分析
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摘要
目的对清镇市第一人民医院重症监护病房(ICU)患者感染病原菌的分布及耐药性进行分析,为抗菌药物的合理应用提供参考依据。方法对2016年1月—2017年12月清镇市第一人民医院ICU患者感染病原菌的构成情况及耐药性进行统计分析。结果 1121份临床标本中痰液标本占51.7%,经培养共分离出非重复菌株352株,其中革兰阴性杆菌占79.8%,革兰阳性球菌占20.2%,病原菌以肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌、铜绿假单胞菌、洋葱伯克霍尔德菌、嗜麦芽寡养单胞菌及金黄色葡萄球菌多见。药敏结果显示,产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌、大肠埃希菌分别占43.2%、47.5%,对亚胺培南的耐药率为3.4%、2.5%;鲍曼不动杆菌对多种抗菌药物的耐药率高于60.0%;铜绿假单胞菌对左氧氟沙星、妥布霉素和阿米卡星的耐药率较低;葡萄球菌中耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)和耐甲氧西林金黄色葡萄球菌(MRSA)分别占92.1%、29.4%,未检出对万古霉素、利奈唑胺和替加环素耐药菌株。结论 ICU患者以下呼吸道感染多见,感染病原菌主要以革兰阴性杆菌为主,病原菌对常用抗菌药物耐药严重,临床医生应重视病原菌的培养及药敏试验,不断提高送检率,根据药敏结果合理应用抗菌药物。
Objective To analyze the distribution and drug resistance of pathogenic bacteria infection in ICU patients in a hospital, and to provide reference for rational use of antibacterial agents. Methods The constitution and drug resistance of pathogen infection in ICU patients in a hospital from January 2016 to December 2017 were statistically analyzed. Results The sputum in 1,121 specimens accounted for 51.7 %, and 352 non-repeat strains were isolated after culture, of which 79.8% were gram-negative bacillus and 20.2% were gram positive coccus.Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii, Pseudomonas aeruginosa, Burkholderia onion,Stenotrophomonas maltophilia and Staphylococcus aureus were mostly found. Extended-spectrum beta-lactamase(ESBLs) phenotype rates of Klebsiella pneumoniae and Escherichia coli showed 43.2% and 47.5%, respectively.The resistance rate to Imipenem was 3.4% and 2.5%. The drug resistance rate of Acinetobacter baumannii to variety antimicrobial agents is higher than 60.0%. The drug resistance rates of Pseudomonas aeruginosa to Levofloxacin,Tobramycin and Amikacin was low. Among Staphylococcus, MRCNS and MRSA accounted for 92.1% and 29.4%,respectively. and no strains resistant to Vancomycin, Linezolid and Tetracycline was detected. Conclusion The following respiratory tract infections are common in ICU patients. The main pathogenic bacteria of infection are gramnegative bacillus. The pathogenic bacteria are seriously resistant to common antibacterial drugs. Clinicians should pay attention to the cultivation of pathogenic bacteria and drug sensitivity test, constantly improve the rate of submission for detection, and rationally use antibiotics according to drug sensitivity results.
Objective To analyze the distribution and drug resistance of pathogenic bacteria infection in ICU patients in a hospital, and to provide reference for rational use of antibacterial agents. Methods The constitution and drug resistance of pathogen infection in ICU patients in a hospital from January 2016 to December 2017 were statistically analyzed. Results The sputum in 1,121 specimens accounted for 51.7 %, and 352 non-repeat strains were isolated after culture, of which 79.8% were gram-negative bacillus and 20.2% were gram positive coccus.Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii, Pseudomonas aeruginosa, Burkholderia onion,Stenotrophomonas maltophilia and Staphylococcus aureus were mostly found. Extended-spectrum beta-lactamase(ESBLs) phenotype rates of Klebsiella pneumoniae and Escherichia coli showed 43.2% and 47.5%, respectively.The resistance rate to Imipenem was 3.4% and 2.5%. The drug resistance rate of Acinetobacter baumannii to variety antimicrobial agents is higher than 60.0%. The drug resistance rates of Pseudomonas aeruginosa to Levofloxacin,Tobramycin and Amikacin was low. Among Staphylococcus, MRCNS and MRSA accounted for 92.1% and 29.4%,respectively. and no strains resistant to Vancomycin, Linezolid and Tetracycline was detected. Conclusion The following respiratory tract infections are common in ICU patients. The main pathogenic bacteria of infection are gramnegative bacillus. The pathogenic bacteria are seriously resistant to common antibacterial drugs. Clinicians should pay attention to the cultivation of pathogenic bacteria and drug sensitivity test, constantly improve the rate of submission for detection, and rationally use antibiotics according to drug sensitivity results.
引文
[1]张璐,王玉青,赵磊,等.ICU患者下呼吸道感染病原菌与耐药性分析[J].中华医院感染学杂志,2016,26(14):3161-3163.
[2]陈育华,周碧云,吴国才,等.ICU病原菌的分布特征及耐药性分析[J].中华医院感染学杂志,2013,23(19):4809-4811.
[3]李鸿飞,邱广斌.3391例ICU感染患者的病原菌菌群分布特点及耐药性分析[J].国际检验医学杂志,2015,36(17):2595-2597.
[4]黄旭军,毛园清,聂根,等.ICU住院患者感染病原菌分布及耐药性分析[J].中华医院感染学杂志,2017,27(9):1963-1966.
[5]彭博,鹿英英,吴珺,等.2014-2016年北京丰台医院ICU感染的病原菌分布及耐药性分析[J].现代药物与临床,2017,32(11):2272-2276.
[6]葛丽卫,杨伟平,罗媛烨,等.2 0 11-2 0 1 5年I C U患者感染病原菌分布及耐药性分析[J].国外医药抗生素分册,2017,38(2):67-71.
[7]康凯,南川川,宋宁,等.2013-2014年ICU患者病原菌分布及耐药性分析[J].中华医院感染学杂志,2016,26(12):2767-27691.
[8]伍益凡,朱从健.某院2015-2016年ICU病原菌分布特点及耐药性分析[J].江苏预防医学,2018,29(1):74-75,93.
[9]胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[10]何磊,邱景富.62株耐碳青霉烯类鲍曼不动杆菌的同源性分析[J].中国感染控制杂志,2018,17(4):299-303.
[11]朱健强,林红燕,钟韵.ICU多重耐药鲍曼不动杆菌分子流行病学调查[J].广州医学院学报,2016,44(1):26-29.
[12]赵德军,胡昭宇,曹雁,等.综合性ICU住院患者下呼吸道鲍曼不动杆菌感染及耐药性监测[J/CD].中华实验和临床感染病杂志:电子版,2015,9(2):242-244.
[13]胡鑫,胡昭宇,曹雁,等.ICU鲍曼不动杆菌感染的流行状况及耐药性分析[J].中国微生态学杂志,2014,26(9):1081-1083.
[14]付玉华,朱文秀,杜希利,等.98株洋葱伯克霍尔德菌临床分布及耐药性[J].中国感染控制杂志,2017,16(3):215-217.
[15]段忠亮,秦娟秀,李敏,等.上海某医院临床分离嗜麦芽窄食单胞菌分子流行病学分析[J].中国感染与化疗杂志,2017,17(3):283-288.
[16]朱吉超,魏莲花,杨永清,等.耐甲氧西林金黄色葡萄球菌临床分布及耐药性分析[J].中华医院感染学杂志,2017,27(7):1462-1465.
[17]古汉福,张国雄.金黄色葡萄球菌耐药性的临床检测及耐药机制分析[J].国际检验医学杂志,2015,36(14):1967-1968,1970.
[18]德军,胡昭宇,曹雁,等.重症监护病房患者耐甲氧西林金黄色葡萄球菌感染及耐药性研究[J].中国消毒学杂志,2014,31(8):835-837,840.
[2]陈育华,周碧云,吴国才,等.ICU病原菌的分布特征及耐药性分析[J].中华医院感染学杂志,2013,23(19):4809-4811.
[3]李鸿飞,邱广斌.3391例ICU感染患者的病原菌菌群分布特点及耐药性分析[J].国际检验医学杂志,2015,36(17):2595-2597.
[4]黄旭军,毛园清,聂根,等.ICU住院患者感染病原菌分布及耐药性分析[J].中华医院感染学杂志,2017,27(9):1963-1966.
[5]彭博,鹿英英,吴珺,等.2014-2016年北京丰台医院ICU感染的病原菌分布及耐药性分析[J].现代药物与临床,2017,32(11):2272-2276.
[6]葛丽卫,杨伟平,罗媛烨,等.2 0 11-2 0 1 5年I C U患者感染病原菌分布及耐药性分析[J].国外医药抗生素分册,2017,38(2):67-71.
[7]康凯,南川川,宋宁,等.2013-2014年ICU患者病原菌分布及耐药性分析[J].中华医院感染学杂志,2016,26(12):2767-27691.
[8]伍益凡,朱从健.某院2015-2016年ICU病原菌分布特点及耐药性分析[J].江苏预防医学,2018,29(1):74-75,93.
[9]胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[10]何磊,邱景富.62株耐碳青霉烯类鲍曼不动杆菌的同源性分析[J].中国感染控制杂志,2018,17(4):299-303.
[11]朱健强,林红燕,钟韵.ICU多重耐药鲍曼不动杆菌分子流行病学调查[J].广州医学院学报,2016,44(1):26-29.
[12]赵德军,胡昭宇,曹雁,等.综合性ICU住院患者下呼吸道鲍曼不动杆菌感染及耐药性监测[J/CD].中华实验和临床感染病杂志:电子版,2015,9(2):242-244.
[13]胡鑫,胡昭宇,曹雁,等.ICU鲍曼不动杆菌感染的流行状况及耐药性分析[J].中国微生态学杂志,2014,26(9):1081-1083.
[14]付玉华,朱文秀,杜希利,等.98株洋葱伯克霍尔德菌临床分布及耐药性[J].中国感染控制杂志,2017,16(3):215-217.
[15]段忠亮,秦娟秀,李敏,等.上海某医院临床分离嗜麦芽窄食单胞菌分子流行病学分析[J].中国感染与化疗杂志,2017,17(3):283-288.
[16]朱吉超,魏莲花,杨永清,等.耐甲氧西林金黄色葡萄球菌临床分布及耐药性分析[J].中华医院感染学杂志,2017,27(7):1462-1465.
[17]古汉福,张国雄.金黄色葡萄球菌耐药性的临床检测及耐药机制分析[J].国际检验医学杂志,2015,36(14):1967-1968,1970.
[18]德军,胡昭宇,曹雁,等.重症监护病房患者耐甲氧西林金黄色葡萄球菌感染及耐药性研究[J].中国消毒学杂志,2014,31(8):835-837,840.