2010-2011年重症监护病房病原菌分布及耐药性分析

目的 分析综合性重症监护病房(ICU)在2010-2011年间常见病原菌的分布及其耐药现状,为临床合理用药和控制医院感染提供参考依据.方法 对2010-2011年从ICU医院感染患者的各类标本中分离出病原菌共为1949株(1079株、870株),采用K-B纸片扩散法进行药物敏感试验,检测病原菌耐药性.结果 以呼吸道标本(痰和导管)的分离率最高为72.1％、病原菌以革兰阴性杆菌为主占66.9％,分别占2010年、2011年标本总量的62.3％和72.4％,革兰阴性杆菌呈上升趋势；其次为真菌感染占19.2％( 22.0％、15.6％),革兰阳性球菌占12.2％( 14.2％、9.7％).病原菌的耐药率普遍较高,耐甲氧西林金黄色葡萄球菌(MRSA)检出率为25.8％,大肠埃希菌和肺炎克雷伯菌的ESBLs检出率分别为61.0％和27.2％.结论 ICU医院感染患者呼吸道感染最多,以细菌为主,尿路感染其次,以真菌为主；病原菌耐药情况严重,应加强病原菌分布及耐药率的监测以减少多药耐药菌产生、降低医院感染率.

Analysis of pathogen distribution and drug resistance in Intensive Care Unit during 2010-2011

Objective To investigate the distribution and drug resistance of pathogenic bacteria in Shaoxing People＇s Hospital intensive care unit （ICU） , and provide references for rational use of antibiotics in clinical practice and hospital infection control. Methods 1 949 （ 1 097 and 870） clinical isolates were collected from different samples of infective patients in ICU in 2010 and 2011, and drug sensitivity test was conducted based on disk diffusion testing （K-B）. Results The highest isolating rate was 72.1% , which came from the respiratory tract samples （sputa and catheters）. Among the samples, gramnegative bacilli （ 66.9% ） were the predominant pathogen, accounting for 62.3%0 and 72.4% of the total samples in 2010 and 2011 respectively. Compared to 2010, Gram-negative bacilli increased obviously in 2011. The fungal infection accounted for 19.2% （22% , 15.6% ） and gram positive cocci accounted for 12.2% （14.2%, 9.7% ）. The rate of bacterial drug resistance was high. The detection rate of methicillin-resistant Staphylococcus aureus （MRSA） was 25.8% , while those of Escherichia coli and Klebsiella ESBLs were 61.0% and 27.2% , respectively. Conclusion ICU patients＇ infection were mainly respiratory tract infection and urinary tract infection, with high drug resistance. The monitoring for pathogen distribution and drug resistance should be strengthened, and drugs should be used rationally to reduce the incidence of nosocomial infections.