摘要
目的监测本院重症监护病房（ICU）血流感染患者细菌分布及耐药状况，为临床合理选用抗菌药物提供依据。方法收集本院ICU2010年1月至2012年12月送检病原学标本，包括全血、导管血和骨髓标本分离的病原菌，采用纸片扩散法、微量稀释法或Etest法测定病原菌的药物敏感性，统计病原菌分布和抗菌药物耐药率。结果3年共903例血流感染患者、分离得到病原菌1077株，其中革兰阳性（G＋）菌639株、占59．33％，革兰阴性（G-）菌438株、占40．67％；排名前5位的病原菌依次为表皮葡萄球菌（20．06％，216株）、大肠埃希菌（13．93％，150株）、鲍曼不动杆菌（10．03％，108株）、肺炎克雷伯菌（7．80％，84株）、金黄色葡萄球菌（6．96％，75株），3年间细菌种类分布无差异。表皮葡萄球菌对多数测试药物的耐药率高于金黄色葡萄球菌，其中表皮葡萄球菌对喹努普汀／达福普汀（4．2％）和呋喃西林（15．3％）的耐药率相对较低，对青霉素（94．4％）、利奈唑烷（93．1％）、哌拉西林／他唑巴坦（90．3％）、头孢哌酮／舒巴坦（87．5％）和苯唑西林（83．3％）的耐药率均高于80％；金黄色葡萄球菌对青霉素（96．0％）、头孢哌酮／舒巴坦（84．0％）、利奈唑烷（76．0％）和苯唑西林（76．0％）的耐药率均高于70％，对其他常见抗菌药物的耐药率均低于70％。鲍曼不动杆菌对阿米卡星的耐药率为38．9％，对呋喃西林（91．7％）、头孢替坦（88．9％）、头孢他啶（88．9％）、氨苄西林（88．9％）、头孢曲松（86．1％）、头孢吡肟（86．1％）、氨曲南（80．6％）和头孢唑啉（80．6％）的耐药率均高于80％；大肠埃希菌除对阿米卡星（30．0％）、头孢替坦（24．0％）和亚胺培南（16．0％）的耐药率低于30％外，对氨苄西林／舒巴坦（94．0％）、左氧氟沙星（84．0％）、氨苄西林（84．0％）和头孢曲松（80．0％）的耐药率均高于80％。结论ICU血流感染患者的病原菌中G＋菌和G-菌的比例分别为59．33％和40．67％；而耐药率则G-菌较G＋菌严重，主要致病菌的耐药率平均高达60％以上；在获得药敏结果前的经验性用药应兼顾G-菌及G＋菌。
Objective To investigate the distribution and antibiotic resistance of bacteria causing bloodstream infections in intensive care unit （ICU） patients and to provide a basis for rational clinical use of antibiotics. Methods The data of positive specimens, including whole blood, catheter blood and bone marrow samples, were isolated from ICU patients from January 2010 to December 2012. Disc diffusion method, micro-dilution and Etest method were used to test drug sensitivity. Distribution and antibiotic resistance of bacteria were analyzed retrospectively. Results A total of 1077 strains were isolated from 903 patients with bloodstream infection during 3 years. Gram-positive （G＋） bacteria and Gram-negative （G-） bacteria accounted for 59.33% （639 isolates） and 40.67% （438 isolates） respectively. The 5 most frequently isolated bacteria were Staphylococcus epidermidis （20.06% , 216 isolates） followed in order by Escheriehia coli （ 13.93%, 150 isolates ）, Acinetobaeter baumannff （ 10.03%, 108 isolates ）, Klebsiella pneumonia （7.80% , 84 isolates） and Staphylococcus aureus （6.96% , 75 isolates）. There was no significant difference in distribution of bacteria during 3 years. The resistance rate of Staphylococcus epidermidis was higher than that of Staphylococcus aureus to most of the tested drugs. The resistance rate of Staphylococcus epidermidis to quinoline/dalfopristin （4.2%） and nitrofurazone （15.3%） was relatively low, while resistance to penicillin （94.4%）, linezolid （93.1% ）, piperacillin/tazobactam （90.3%）, cefoperazone/sulbactam （87.5%） and oxacillin （83.3%） was over 80%. The resistance rate of Staphylococcus aureus to penicillin （96.0%）, cefoperazone/sulbactam （84.0%）, linezolid （76.0%） and oxacillin （76.0%） was over 70%, and resistance to the other common antibacterial drugs was below 70%. The resistance rate of Acinetobacter baumannff to amikacin （38.9%）, nitrofurazone （91.7%）, cefotetan （88.9%）, ceftazidime （88.9%）, ampicillin （88.9%）, ceftriaxone （86.1%）, the cefepime （86.1%）, aztreonam （80.6%） and cefazolin （80.6%）, and overall above 80%. The resistance rate of Eseherichia coli to amikacin （30.0%）, cefotetan （24.0%） and imipenem （16.0%） was below 30%, while resistance to ampicillin/sulbactam （94.0%）, levofloxacin （84.0%）, ampicillin （84.0%） and ceftriaxone （80.0%） was over 80%. Conclusions Among the bacteria causing bloodstream infection as isolated from ICU patients, G＋ and G- bacteria accounted for 59.33% and 40.67%, respectively. The resistance rate of G- was higher than that of G＋, and resistance rate of majority of bacteria was higher than 60% on average. Before obtaining the susceptibility test results, both G- and G＋ should be taken into account on choosing antimicrobial drugs in the treatment of ICU patients.
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2013年第4期215-218,共4页
Chinese Critical Care Medicine
基金
广东省医学科研基金项目（B2012004）
关键词
血流感染
抗菌药物
细菌耐药
重症监护病房
Bloodstream infection
Antibacterial
Bacterial resistance
Intensive care unit
作者简介
通信作者：曾红科，Email：zenghongke@vip．163．com
