ICU革兰阴性菌院内感染病原菌及耐药变化

目的探讨ICU革兰阴性菌院内感染的病原菌及抗生素耐药情况，为临床防治提供依据。方法对温州医学院附属第一医院ICU2002年1月-2004年12月院内感染的所有标本分离的革兰阴性菌及耐药性进行回顾性分析。结果革兰阴性菌院内感染的部位主要在下呼吸道，其次为尿路。372株G^-菌中，前5位的分别是鲍曼不动杆菌62株（16．67％）、洋葱假单胞菌61株（16．4％）、铜绿假单胞菌58株（15．59％）、嗜麦芽窄食假单胞菌41株（11．02％），肺炎克雷伯杆菌34株（9．14％）。3年中，鲍曼不动杆菌和嗜麦芽窄食假单胞菌所致的院内感染有所增加；在细菌耐药性方面，G^-菌的耐药率普遍提高，对头孢哌酮／舒巴坦（13．25％）、哌拉西彬他唑巴坦（23．93％）、头孢他啶（39．66％）、美罗培南（32．17％）、奈替米星（48．36％）的耐药率〈50％，但对亚胺培南高达50．87％。结论ICU院内感染革兰阴性菌对除头孢他啶外的3代头孢耐药率普遍高，对亚胺培南耐药率高，加强细菌耐药性检测，合理使用抗生素很关键。

Changes of Gram-negative bacilli and drug resistances of nosocomial infections in ICU

Objective To investigate the changes of Gram-negative bacilli and drug resistances of nosocomial infections in ICU in the past three years,contributing to future clinical prevention and treatement.Method A retrospective investigation was made for Gramnegative bacilli as well as their drug resistances from January 2002 to December 2004 in ICU of our hospital.Results 372 Gram-negative bacilli were isolated,including Acinetobacter bauamnnii(62 stains,(16.67%)),Pseudomonas cepaica(61 stains,16.40%),Pseudomonas aeruginosa(58 stains,15.59%),Stenotrophomonas maltophilia(41 stains,11.02%),Klebsiella pneumoniae(34 stains,9.14%).There was an elevated tendency of the resistance rates to common antibacterial in Gram-negative bacilli for the past three years.The resistance rates to cefoperazone/sulbactam(13.25%),piperacillin/tazobactam(23.93%),ceftazidime(39.66%),meropenem(32.17%),netilmicin((48.36%)),were less than 50%,but the resistance rates to imipenem was high(about 50.87%).Conclusions the drug resistances of Gram-negative bacilli of nosocomial infections isolated from ICU was commonly high to cephalosporin(except ceftazidime)and imipenem.Appropriate use of antibiotics,positive and valid prevention,monitoring the prevailing strains and their drug-resistances were crucial.