ICU临床检出革兰阴性菌的分布及耐药性分析-东南大学学报医学版

ICU临床检出革兰阴性菌的分布及耐药性分析

单位：1. 蚌埠医学院第一附属医院重症医学科, 安徽蚌埠 233000;
2. 利辛县人民医院检验科, 安徽亳州 236700;
3. 安徽省组织移植重点实验室, 安徽蚌埠 233000

分类号：R197.323.4

出版年·卷·期（页码）：2021·40·第一期（58-63）

摘要：

目的：分析ICU临床检出革兰阴性菌的分布情况和耐药趋势，协助抗菌药物的规范应用。方法：回顾性分析2019年7至2020年6月某三甲医院综合ICU临床检出革兰阴性菌的分布情况及药敏结果，同时与2019年CHINET三级医院细菌监测结果对比分析。结果：分离得到革兰阴性菌598株，以肠杆菌科细菌多见，肺炎克雷伯菌的检出率逐步升高，前7位依次为肺炎克雷伯菌（24.92%）、鲍曼不动杆菌（21.07%）、铜绿假单胞菌（18.90%）、大肠埃希菌（11.37%）、黏质沙雷菌（5.02%）、洋葱伯克霍尔德菌（4.85%）和奇异变形杆菌（4.51%），标本主要为痰液（73.75%）。药敏结果示大肠埃希菌及肺炎克雷伯菌耐药率高于2019年CHINET三级医院细菌监测结果，多重耐药菌检出率为81.27%，洋葱伯克霍尔德菌多重耐药的检出率为100%（最高），肺炎克雷伯菌多重耐药的检出率为73.15%（最低）。丁胺卡那霉素对常见细菌有着良好的抗菌活性。结论：ICU病原菌以肠杆菌科细菌多见，其中最多见于肺炎克雷伯菌。该院肠杆菌科细菌耐药率高于2019年CHINET三级医院细菌监测结果，多重耐药菌的检出率较高，须规范抗菌药物的使用，加强细菌耐药的监测。

Objective: To analyze the distribution and drug resistance of gram-negative bacteria detected in ICU, and to guide the rational use of antibiotics in clinic. Methods: The distribution and drug sensitivity of Gram-negative bacteria detected by comprehensive ICU in a tertiary hospital from July 2019 to June 2020 were retrospectively analyzed, and compared with the results of bacterial surveillance in CHINET tertiary hospital in 2019. Results: 598 strains of Gram-negative bacteria were isolated, mainly Enterobacteriaceae, and the detection rate of Klebsiella pneumoniae increased gradually. The top 7 bacteria were Klebsiella pneumoniae (24.92%), Acinetobacter baumannii (21.07%), Pseudomonas aeruginosa (18.90%), Escherichia coli (11.37%), Serratia marcescens (5.02%), Burkholderia cepacia (4.85%) and Proteus mirabilis (4.51%). The specimen was mainly collected from sputum (73.75%). The drug sensitivity results showed that the drug resistance rate of Escherichia coli and Klebsiella pneumoniae was higher than that of the CHINET tertiary hospital in 2019. The detection rate of multiple drug resistant bacteria was 81.27%, in which the highest detection rate of multiple drug resistance of Burkholderia cepacia was 100%, and the lowest detection rate of multiple drug resistance of Klebsiella pneumoniae was 73.15%. Amikacin has good antibacterial activity against common bacteria. Conclusion: Enterobacteriaceae is the most common pathogen of ICU, among which Klebsiella pneumoniae is the most common. The drug resistance rate of Enterobacteriaceae bacteria in this hospital is significantly higher than that in the CHINET tertiary hospital in 2019, and the detection rate of multiple drug-resistant bacteria is higher, which requires to standardize the use of antibiotics and strengthen the monitoring of bacterial drug resistance.

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