重症监护病房分离菌菌谱及其耐病性分析

目的了解重症监护病房(ICU)院内分离菌菌谱及细菌耐药情况，为临床防治院内感染提供依据。方法对汕头大学第一附属医院ICU 2000年1月～2003年12月所分离的细菌菌株、真菌及细菌耐药性进行回顾性调查。结果4年共分离获得菌株460株，分离菌仍以G^-菌为主．占57．4％．其次G^ 菌占27．2％，真菌占15．4％。G^ 分离率逐年增多，由2000年的20．7％上升到2003年的28．3％。G^-以肠杆菌属为主。G^ 菌以金黄色葡萄球菌(金葡菌)为主，耐甲氧西林葡萄球菌占G^ 的90．9%。真菌以白色念珠菌为主。前6位分别为金葡菌(13．7％)、肺炎克雷伯杆菌(12．6％)、埃希肠杆菌(11．5％)、白色念珠菌(10．4％)、产气肠杆菌(9．3％)和嗜麦芽窄食黄单胞菌(5．4％)。体外药敏试验显示主要分离菌均呈多重耐病特性。只有万古霉素对G^ 具有很强抗菌活性，敏感率达100％。结论该ICU院内分离菌仍以G菌为主．G^ 菌分离率逐年增多，金葡菌已上升到第1位。细菌呈多重耐药特性，耐甲氧西林葡萄球菌在G^ 菌中比例很高，应高度重视。掌握该地区、该科室常见分离菌菌谱及其耐药特性具有重要意义。

Analysis on spectrum of microorganisma and drugs resistance in intensive care unit

Objective To get knowledge of the spectrum of microorganisms and drugs resistance in intensive care unit(ICU) so as to provide the evidence for treatment.Method The microorganisms isolated from ICU and their drugs resistance were retrospectively analysed from January 2000 through December 2003. Results There were 460 microorganisms isolated from ICU during the past 4 years. Gram-negative bacteria (G-,57.5%) was still the main isolates in ICU ,followed by Gram-positive bacteria(G+,27.2%) and fungi(15.4%). The isolated rate of G+ was increasing yearly and that was from 20.7% in 2000 up to 28.3% in 2003. The most frequent isolates were Staphylococcus aureus(SA,13.7%), Klebsiella pneumoniae(12.6%), Escherichia coli(11.5%), Candida albicans(10.4%),Enterobacter aerogenes(9.3%) and Stenotrophomas maltophilia(SM,5.4%) in turn. The drugs susceptibility test in vitro showed that the main organisms were all in multi-drug resistance. Only vacomycin had very high sensitivity against G+.Conclusions The G- was still the most prevalence isolates in ICU. The isolated rete of G+ was increasing yearly and SA was in the first position of all isolates.So it's important to survey the characteristic of the spectrum of microorganisms and drugs resistance in your own department.