急诊重症监护病房革兰阴性杆菌感染分布及耐药性
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摘要
目的了解2011年1月至2013年12月急诊重症监护病房(EICU)分离革兰阴性杆菌的临床分布及耐药性,为临床治疗提供参考.方法对2011年1月至2013年12月EICU住院患者各类标本中检出的942株革兰阴性杆菌感染分布、耐药性进行了回顾性分析,革兰阴性杆菌分离培养鉴定和药敏试验严格按操作规程进行.统计分析采用WHONET 5.5软件进行处理.结果 EICU临床标本中共检出革兰阴性杆菌942株,其中排名前三位的为鲍曼不动杆菌、肺炎克雷伯菌和大肠埃希菌,鲍曼不动杆菌的检出率呈逐年上升趋势,鲍曼不动杆菌对多数抗生素的耐药率高达90%;肺炎克雷伯菌对碳青霉烯类抗生素耐药率明显上升.结论 EICU检出的鲍曼不动杆菌对常用抗生素的耐药性总体呈逐年上升趋势,其明显高于其他革兰阴性杆菌,耐药现状严峻.应严格执行卫计委《抗菌药物临床应用管理办法》,将鲍曼不动杆菌列入医院监控的重点菌株中,实行医院细菌耐药的预警公示制度,防止多重耐药和泛耐药菌株在科室内的传播,从而控制细菌耐药性的上升.
Objective To analyze the Gram-negative bacilli's distribution and antibiotic resistance status in EICU from 2011 to 2013, and provide a referrence for clinical treatment. Methods We collected Gram-negative bacilli in EICU inpatients' specimens from 2011 to 2013,for the retrospective analysis of infection distribution and resistance. Bacterial culture, identification and drug sensitivity tests were all according to Standard Operating Procedures. The data were analyzed by WHONET5.5. Statistics software. Results In the recent 3 years, 942 strains of Gram-negative bacilli were detected in EICU, the top three were Acinetobacter baumannii, Klebsiella pneumoniae and Escherichia coli. The detection rate of Acinetobacter baumannii increased year by year.Acinetobacter baumannii's resistance rate to most antibiotics was up to 90%. Klebsiella pneumoniae's resistance rate to Carbapenems increased significantly. Conclusions Acinetobacter baumannii's resistance rate to commonly used antibiotics is increasing year by year and significantly higher than other Gram-negative bacilli in EICU. The resistance status is severe. We should strictly carry out Methods clinical application of antibacterial drug management by National Health and Family Planning Commission of the People's Republic of China, and included Acinetobacterbaumannii in the key strains of hospital monitoring, perform early warning and publicity of resistance, to prevent the spread of multi-resistant and pan-resistant strains and control the resistance rate.
Objective To analyze the Gram-negative bacilli's distribution and antibiotic resistance status in EICU from 2011 to 2013, and provide a referrence for clinical treatment. Methods We collected Gram-negative bacilli in EICU inpatients' specimens from 2011 to 2013,for the retrospective analysis of infection distribution and resistance. Bacterial culture, identification and drug sensitivity tests were all according to Standard Operating Procedures. The data were analyzed by WHONET5.5. Statistics software. Results In the recent 3 years, 942 strains of Gram-negative bacilli were detected in EICU, the top three were Acinetobacter baumannii, Klebsiella pneumoniae and Escherichia coli. The detection rate of Acinetobacter baumannii increased year by year.Acinetobacter baumannii's resistance rate to most antibiotics was up to 90%. Klebsiella pneumoniae's resistance rate to Carbapenems increased significantly. Conclusions Acinetobacter baumannii's resistance rate to commonly used antibiotics is increasing year by year and significantly higher than other Gram-negative bacilli in EICU. The resistance status is severe. We should strictly carry out Methods clinical application of antibacterial drug management by National Health and Family Planning Commission of the People's Republic of China, and included Acinetobacterbaumannii in the key strains of hospital monitoring, perform early warning and publicity of resistance, to prevent the spread of multi-resistant and pan-resistant strains and control the resistance rate.
引文
[1]ARIAS C A,MURRAY B E.Antibiotic-resistant bugs in the 21st century-a clinical super-challenge[J].N Engl J Med,2009,360(5):439-443.
[2]蒋海平,向华珍,吴艳涛,等.鲍曼不动杆菌临床分布及耐药性分析[J].中华医院感染学杂志,2014,24(22):5 486-5 488.
[3]胡付品,朱德妹,汪复,等.2011年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2012,12(5):321-329.
[4]胡付品,朱德妹,汪复,等.2012中国CHINET细菌耐药性监测结果[J].中国感染与化疗杂志,2013,13(5):321-330.
[5]ELEMAM A,RAHIMIAN J,MANDELL W.Infection with panresistant Klebsiella pneumoniae:a report of 2 cases and a brief review of the literature[J].Clin Infect Dis,2009,49(2):271-274.
[6]BOUCHER H W,TALBOT G H,BRADLEY J S,et al.Bad bugs,no drugs:no ESKAPE!An update from the infectious diseases society of america[J].Clin Inf Dis,2009,48(1):1-12.
[7]WISE R.The urgent need for new antibacterial agents[J].J Antimierob Chemotherapy,2011,66(9):1 939-1 940.
[8]MOIIEL D G,BEATSON S A,WULPEL D J,et al.Identification of novel Vaccine candidates against multidrug-resistant Acinetobacter baumannii[J].PLos 0ne,2013,8(10):e77 631.
[9]GAYNES R,EDWARDS J R.National Nosocomial Infectious sunreil-1ance System.Overview of nosoconlial infections caused by gram-negative bacilli[J].Clin Infect Dis,2005,41(6):848-854.
[10]王侠,郭庆合,赵庆伟,等.2009-2011年医院感染革兰阴性杆菌耐药性分析[J].中华医院感染学杂志,2014,24(17):4 171-4 173.
[2]蒋海平,向华珍,吴艳涛,等.鲍曼不动杆菌临床分布及耐药性分析[J].中华医院感染学杂志,2014,24(22):5 486-5 488.
[3]胡付品,朱德妹,汪复,等.2011年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2012,12(5):321-329.
[4]胡付品,朱德妹,汪复,等.2012中国CHINET细菌耐药性监测结果[J].中国感染与化疗杂志,2013,13(5):321-330.
[5]ELEMAM A,RAHIMIAN J,MANDELL W.Infection with panresistant Klebsiella pneumoniae:a report of 2 cases and a brief review of the literature[J].Clin Infect Dis,2009,49(2):271-274.
[6]BOUCHER H W,TALBOT G H,BRADLEY J S,et al.Bad bugs,no drugs:no ESKAPE!An update from the infectious diseases society of america[J].Clin Inf Dis,2009,48(1):1-12.
[7]WISE R.The urgent need for new antibacterial agents[J].J Antimierob Chemotherapy,2011,66(9):1 939-1 940.
[8]MOIIEL D G,BEATSON S A,WULPEL D J,et al.Identification of novel Vaccine candidates against multidrug-resistant Acinetobacter baumannii[J].PLos 0ne,2013,8(10):e77 631.
[9]GAYNES R,EDWARDS J R.National Nosocomial Infectious sunreil-1ance System.Overview of nosoconlial infections caused by gram-negative bacilli[J].Clin Infect Dis,2005,41(6):848-854.
[10]王侠,郭庆合,赵庆伟,等.2009-2011年医院感染革兰阴性杆菌耐药性分析[J].中华医院感染学杂志,2014,24(17):4 171-4 173.