重症监护室患者致病菌监测及耐药性分析

发布时间：2018-03-21 21:51

本文选题：重症监护室　切入点：医院感染　出处：《中国呼吸与危重监护杂志》2016年05期 　论文类型：期刊论文

【摘要】：目的了解重症监护室患者致病菌感染和耐药情况,为预防重症感染和经验用药提供参考依据。方法回顾性分析2013年1月至2014年12月首都医科大学附属北京安贞医院重症监护室的住院患者,细菌及真菌培养阳性病例,分析其菌群分布及致病菌耐药性。结果 2年间重症监护室患者共收集临床非重复分离株2 088株,其中革兰阴性菌1403株(67.2%),革兰阳性菌496株(23.8%),真菌189株(9.0%)。痰液等呼吸道标本1324株(63.42%);血液标本487株(23.33%);其他标本277株(13.27%)。分离出鲍曼不动杆菌(17.2%)、肺炎克雷伯菌(14.8%)、铜绿假单胞菌(9.9%)、白念珠菌(6.3%)、大肠埃希菌(5.6%)、阴沟肠杆菌(5.4%)、表皮葡萄球菌(5.0%)及金黄色葡萄球菌(4.7%)。碳青霉烯类耐药肠杆菌科细菌(CRE)15株,占2.3%,其中肺炎克雷伯菌5株,阴沟肠杆菌4株。大肠杆菌中多耐药菌株占86.4%,其中MDR占85.5%,XDR占0.9%;鲍曼不动杆菌中多耐药菌株占75.2%,其中XDR占72.1%,MDR占3.1%;铜绿假单胞菌中多耐药菌株占10.6%。MRSA及MRCNS检出率分别为49.0%和95.5%,耐万古霉素肠球菌(VRE)4株,均为粪肠球菌。真菌中白念珠菌131株(69.3%),光滑球念珠菌23株(12.2%)。白念珠菌对两性霉素及5氟胞嘧啶均敏感,对其他抗菌素耐药率小于1%;光滑球念珠菌耐药率较白念珠菌及近平滑念珠菌高,但仍全部小于15%。结论重症监护室患者致病菌以革兰阴性菌为主,排名前8位的致病菌分别是鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌、白念珠菌、大肠埃希菌、阴沟肠杆菌、表皮葡萄球菌及金黄色葡萄球菌。痰液及血液标本多见。CRE占2.3%。大肠杆菌中多耐药菌株最多,但主要以MDR为主;其次为鲍曼不动杆菌,以XDR为主;铜绿假单胞菌中耐药菌株最少。真菌中白念珠菌最多,耐药率仍较低。
[Abstract]:Objective to investigate the pathogenic bacteria infection and drug resistance in intensive care unit (ICU) patients. Methods from January 2013 to December 2014, we retrospectively analyzed the positive cases of bacteria and fungi culture in intensive care unit of Beijing Anzhen Hospital affiliated to Capital Medical University. Results in the past two years, 2088 clinical non-repeated isolates were collected from patients in intensive care unit. 1403 strains of Gram-negative bacteria, 496 strains of Gram-positive bacteria, 1403 strains of Gram-positive bacteria, 189 strains of fungi, 1324 strains of sputum, 1324 strains of respiratory tract specimens, including sputum and other respiratory tract specimens, 1324 strains, 63.42%, 1324 strains of sputum, 1324 strains of sputum, 1324 strains of sputum, 1324 strains of sputum, 1324 strains of sputum, 1324 strains of sputum, 1324 strains of sputum, 1324 strains of sputum, 1324 strains of sputum, 1324 strains of sputum, 1324 strains of sputum, 1324 strains of sputum, 1324 strains of sputum, 1324 strains of sputum. 9. 9%, C. albicans 6. 3%, Escherichia coli 5. 6%, Enterobacter cloacae 5. 4%, Staphylococcus epidermidis 5. 0) and Staphylococcus aureus 4. 70.There are 15 strains of carbapenem resistant Enterobacteriaceae. Accounting for 2.3% of which 5 strains of Klebsiella pneumoniae, Four strains of Enterobacter cloacae were isolated from Escherichia coli, of which 85.5% were MDR, 75.2% were multidrug resistant, 72.1% were XDR and 3.1% were multidrug resistant in Pseudomonas aeruginosa, respectively, the positive rates of 10.6%.MRSA and MRCNS in Pseudomonas aeruginosa were 85.5%, 75.2%, 72.1% and 3.1% respectively in Acinetobacter baumannii and Pseudomonas aeruginosa. 49.0% and 95.5% of them were resistant to vancomycin, 4 strains of Enterococcus vancomycin, All of them were Enterococcus faecalis. Among them, 131 strains of Candida albicans and 23 strains of Candida smooth were found to be sensitive to amphotericin and 5-fluorocytosine. The drug resistance rate of Candida smooth was higher than that of Candida albicans and Candida albicans, but all of them were less than 15. Conclusion Gram-negative bacteria are the main pathogenic bacteria in intensive care unit. The top 8 pathogens were Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, Candida albicans, Escherichia coli, Enterobacter cloacae. Staphylococcus epidermidis and Staphylococcus aureus. The sputum and blood samples were mainly found in sputum and blood. The multidrug resistant strains in Escherichia coli were mostly MDR, followed by Acinetobacter baumannii and XDR. Pseudomonas aeruginosa was the least resistant strain and Candida albicans was the most and the resistance rate was still low.
【作者单位】：首都医科大学附属北京安贞医院;
【分类号】：R459.7

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