ICU与非ICU感染患者病原菌分布及耐药性对比分析

Distribution and drug resistance of pathogens isolated from patients in intensive care units and nonintensive care units

摘要:

目的分析重症监护室（ICU）与非ICU患者感染病原菌的分布和耐药情况，为临床抗感染治疗提供依据。方法对2006年5月—2007年5月临床各科室送检标本进行细菌分离培养与鉴定，并对ICU与非ICU患者感染病原菌分布及耐药性进行对比分析。结果从ICU患者标本中分离培养出病原菌150株，其中非发酵菌总构成比为40.67％（61/150）；非ICU患者标本分离培养出病原菌495株，非发酵菌总构成比为17.98％（89/495）。ICU患者非发酵菌检出率高于非ICU患者（χ2 ＝33.20，P＜0.01）。ICU患者分离的主要病原菌依次为真菌（21.33％）、铜绿假单胞菌（17.33％）、大肠埃希菌（12.67％）；非ICU患者分离的主要病原菌依次为真菌（20.61％）、大肠埃希菌（17.98％）、金黄色葡萄球菌（10.30％）。ICU患者感染的鲍曼不动杆菌和金黄色葡萄球菌耐药较严重；第三代头孢菌素在治疗革兰阴性杆菌感染时，ICU与非ICU患者耐药差异较大。结论ICU患者非发酵菌检出率高，其感染的病原菌耐药严重，应加强管理与监测。

Abstract:

ObjectiveTo analyze the distribution and drug  resistance of pathogens isolated from patients in intensive care units( ICUs) and  nonICUs, so as to provide evidence for clinical antiinfective treatment. MethodsBacterial  strains from patients in clinical departments from May 2006 to May 2007 were isolated and identified,  pathogenic distribution and antimicrobial resistance  between ICUs and nonICUs were compared and analyzed.ResultsOne hundred and fifty strains were isolated from patients in ICUs, the constitutional ratio of nonfermentative bacteria was 40.67%(61/150); 495 strains were isolated from nonICUs, the constitutional ratio of nonfermentative bacteria  was 17.98%(89/495). The isolation rate of nonfermentative bacteria from ICUs was higher than that of nonICUs (χ2=33.20，P<0.01). The most common pathogens in ICUs were fungi（21.33％），Pseudomonas aeruginosa（17.33％） and Escherichia coli（12.67％）; The most common pathogens in nonICU were fungi (20.61%)，Escherichia coli (17.98%) and Staphylococcus aureus (10.30%). Antimicrobial resistance of Acinetobacter baumannii and Staphylococcus aureus isolated from ICUs were serious;  The resistance to the third generation cephalosporins for treating infection with gramnegative bacilli was quite different between ICUs and nonICUs.ConclusionThe isolation rate of nonfermentative bacteria in ICUs is high, and drug resistance is serious, which should be given strengthened management and surveillance.