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ICU临床检出革兰阴性菌的分布及耐药性分析
作者:楚新旭1  邹琪1  段雨晨2  王娇3  何先弟1 
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
关键词:重症监护室 革兰阴性菌 细菌耐药性监测 
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.

参考文献:

[1] 姚宏武,索继江,邢玉斌,等.我国的医院感染管理与防控现状调研及分析[J].中华医院感染学杂志,2018,28(10):1563-1568.
[2] 胡付品,郭燕,朱德妹,等.2019年CHINET三级医院细菌耐药监测[J].中国感染与化疗杂志,2020,20(3):233-243.
[3] EMPAIRE G D,GUZMAN SIRITT M E,ROSENTHAL V D,et al.Multicenter prospective study on device-associated infection rates and bacterial resistance in intensive care units of Venezuela:International Nosocomial Infection Control Consortium (INICC) findings[J].Int Health,2017,9(1):44-49.
[4] KIM B,HWANG I S,LEE H J,et al.Identification of a molecular marker tightly linked to bacterial wilt resistance in tomato by genome-wide SNP analysis[J].Theor Appl Genet,2018,131(5):1017-1030.
[5] MICOZZI A,GENTILE G,MINOTTI C,et al.Carbapenem-resistant Klebsiella pneumoniae in high-risk haematological patients:factors favouring spread,risk factors and outcome of carbapenem-resistant Klebsiella pneumoniae bacteremias[J].BMC Infect Dis,2017,17(1):203-215.
[6] SATLIN M J,COHEN N,MA K C,et al.Bacteremia due to carbapenem-resistant Enterobacteriaceae in neutropenic patients with hematologic malignancies[J].J Infect,2016,73(4):336-345.
[7] HU F P,GUO Y,ZHU D M,et al.Resistance trends among clinical isolates in China reported from CHINET surveillance of bacterial resistance,2005-2014[J].Clin Microbiol Infect,2016,22(1):9-14.
[8] TARCHINI G.Tigecycline and bacteremia-the dangers of post hoc analysis of pooled data[J].Clin Infect Dis,2010,51(7):867-868.
[9] RICHTER S E,MILLER L,USLAN D Z,et al.Risk factors for colistin resistance among Gram-negative rods and Klebsiella pneumoniae isolates[J].J Clin Microbiol,2018,56(9):9-18.
[10] ZHENG J X,LIN Z W,SUN X,et al.Overexpression of OqxAB and MacAB efflux pumps contributes to eravacycline resistance and heteroresistance in clinical isolates of Klebsiella pneumoniae[J].Emerg Microbes Infect,2018,7(1):139-150.
[11] YIN D,WU S,YANG Y,et al.Results from the China Antimicrobial Surveillance Network (CHINET) in 2017 of the activities of ceftazidime-avibactam and ceftolozane-tazobactam against clinical isolates of Enterobacteriaceae and Pseudomonas aeruginosa[J].Antimicrob Agents Chemother,2019,63(4):1-18.
[12] 吴强,汪华学,郭普,等.ICU肺部感染患者痰标本的病原学分析[J].蚌埠医学院学报,2012,37(8):981-984.
[13] ADUKWU E C,BOWLES M,EDWARDS-JONES V,et al.Antimicrobial activity,cytotoxicity and chemical analysis of lemongrass essential oil (cymbopogon flexuosus) and pure citral[J].Appl Microbiol Biotechnol,2016,100(22):9619-9627.
[14] 阮永春,周宜庆,张海旺,等.替加环素耐药肺炎克雷伯菌的分布及耐药性分析[J].中华全科医学,2020,18(8):1404-1408.
[15] 陆春婉,苏爱康,王丹凤.急诊ICU洋葱伯克霍尔德菌感染的分布与耐药分析[J].中华医院感染学杂志,2019,29(18):2759-2762.
[16] 王铮铮,许小敏.2016年宁波某三甲医院病原菌分布及耐药性监测分析[J].中国抗生素杂志,2018,43(10):1232-1237.
[17] 任宏涛,时东彦,左江华,等.河北邢台市人民医院2017年细菌耐药性监测[J].中国抗生素杂志,2019,44(2):241-247.
[18] 尚鲁强,徐学慧,燕丽萍.痰涂片检出白细胞吞噬细菌在急性细菌性肺炎诊断中的价值[J].当代医学,2020,26(3):167-169.

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