重症监护室常见革兰阴性杆菌分布及耐药性

Distribution and drug resistance of common gramnegative bacilli in an intensive care unit

摘要:

目的了解某院重症监护室（ICU）常见革兰阴性（G-）杆菌的分布及其耐药情况。方法回顾性分析该院ICU病区2008—2010年分离的常见G-杆菌种类及其药敏试验结果。细菌鉴定和药敏试验，采用法国生物梅里埃公司（bioMerieux）VITEK2全自动微生物分析仪进行。应用WHONET5.5软件对数据进行统计分析。结果1 551株G-杆菌标本来源以痰液为主（68.06%）；常见G-杆菌以鲍曼不动杆菌所占比率最大（25.40%，394株），其次为肺炎克雷伯菌（21.66%，336株）、大肠埃希菌（16.76%，260株）和铜绿假单胞菌（15.86%，246株）等；产超广谱β内酰胺酶（ESBLs）肺炎克雷伯菌和大肠埃希菌株数分别为198株（58.93%）和174株（66.92%）。常见G-杆菌敏感性较好的抗菌药物主要为哌拉西林/他唑巴坦（耐药率19.23%～31.73%）、亚胺培南（耐药率9.23%～37.40%）、头孢哌酮/舒巴坦（耐药率14.88%～32.23%）、阿米卡星（耐药率22.92%～27.66%）。结论ICU病区的常见G-杆菌多重耐药现象严重，临床应根据药敏试验结果合理使用抗菌药物，以减少耐药菌株的产生。

Abstract:

ObjectiveTo investigate the distribution and drug resistance of common gramnegative bacilli in intensive care unit （ICU） in a hospital.MethodsThe species and drug susceptibility test of the common gramnegative bacilli isolated from ICU between 2008 and 2010 were analyzed retrospectively. Bacteria were identified and performed antimicrobial  susceptibility test with VITEK2（bioMerieux） system. The date were analyzed by the software “WHONET5.5”.ResultsOf 1 551 gramnegative bacilli isolates, 68.06% were isolated from sputum; among the common gramnegative bacilli, the first one was Acinetobacter baumannii, which accounting for 25.40% (394 strains), followed by  Klebsiella pneumoniae (21.66%,336 strains), Escherchia coli (16.76%,260 strains), and Pseudomonas aeruginosa (15.86%, 246 strains),etc; 198(58.93%) strains of Klebsiella pneumoniae and 174(66.92%) of Escherichia coli were extendedspectrum βlactamaseproducing  strains. The common gramnegative bacilli had very low resistant rates to  piperacillin/tazobactam, imipenem, cefoperizone/sulbactam and amikacin, the resistant rates was 19.23%-31.73%,9.23%-37.40%, 14.88%-32.23%, and 22.92%-27.66%,respectively.ConclusionMultidrug resistance among the common gramnegative bacilli in ICU is very serious . In order to reduce the emergence of drugresistant bacterial strain, it is important to use  antimicrobial agents correctly based on drug susceptibility test result.