江波

[摘要] 目的 了解成都市中西医结合医院重症加强治疗病房细菌分布及耐药情况，为临床合理使用抗菌药物提供参考。方法 回顾性分析成都市中西医结合医院重症医学科2011年1月—2014年1月送检标本所分离的细菌及其耐药性。结果 共分离细菌632株，其中革兰阴性菌479株（75.8%），革兰阳性菌株153株（24.2%）。革兰氏阴性菌排名前5的分别为铜绿假单胞菌103株（16.3%）、鲍曼不动杆菌100株（15.8%）、肺炎克雷伯菌85株（13.4%）、大肠肠埃希菌72株（11.4%）、阴沟肠杆菌43株（6.8%），革兰氏阳性菌排名前3位的分别为金黄色葡萄球菌68株（10.8%），表皮葡萄球菌37株（5.9%），溶血葡萄球菌24株（3.8%）。鲍曼不动杆菌和铜绿假单胞菌多为多重耐药菌株，对亚胺培南耐药率分别为82.3%和52.4%。大肠埃希菌对三代头孢菌素、头孢吡肟、氨曲南及喹诺酮类的耐药率均>70.0%。耐甲氧西林金黄色葡萄球菌、表皮葡萄球菌和溶血葡萄球菌的检出率分别为88.5%、98.4%和98.2%，尚未检出对万古霉素及利奈唑胺耐药的葡萄球菌属。 结论 革兰阴性菌为该院重症加强治疗病房主要致病细菌，耐甲氧西林葡萄球菌呈增多趋势。细菌耐药情况较为严重且呈现多重耐药趋势，应采取积极有效措施予以防控。

[关键词] 重症加强治疗病房；细菌分布；耐药性

[中图分类号] R4 [文献标识码] A [文章编号] 1674-0742（2015）08（b）-0014-03

[Abstract] Objective To determine the bacteria distribution and drug resistance in the ICU of Chengdu Integrated TCM&Western Medicine Hospital so as to provide reference for clinical appropriate use of antibacterials. Methods A retrospective analysis was conducted on the distribution and drug resistance of bacteria isolated from the specimens of ICU of Chengdu Integrated TCM&Western Medicine Hospital from January 2011 to January 2014. Results A total of 632 strains of bacteria were isolated in the survey period， which included 479（75.8%） gram-negative strains， 153（24.2%） gram-positive strains. Pseudomonas aeruginosa（103 strains， 16.3%）， Acinetobacter baumannii（100 strains， 15.8%）， Klebsiella pneumoniae（85 strains， 13.4%）， E. coli（72 strains， 11.4%） and Enterobacter cloacae（43 strains， 6.8%） were the five most common gram-negative strains. Staphylococcus aureus （68 strains， 10.8%）， Staphylococcus epidermidis （37 strains， 5.9%） and Staphylococcus haemolyticus（24 strains， 3.8%） were the three most common gram-positive strains. The most of Acinetobacter baumannii and Pseudomonas aeruginosa were multiple drug-resistant strains， the drug resistance rates to Imipenem were 82.3% and 52.4%. The drug resistance rates of E. Coli to the third generation cephalosporin， cefepime， aztreonam and quinolones fluoroquinolones were above 70.0%. The methicillin-resistant detection rate of Staphylococcus aureus， Staphylococcus epidermidis and Staphylococcus haemolyticus was 88.5%， 98.4% and 98.2%， respectively. No Staphylococcus strain was resistant to vancomycin and linezolid. Conclusion Gram-negative strains were the predominant bacteria in the ICU of Chengdu Integrated TCM&Western Medicine Hospital， the methicillin-resistant Staphylococcus aureus showed a trend of increase. More positive and effective measures should be taken to control and prevent the worsening drug resistance and multidrug resistance of the bacteria.

[Key words] ICU； Bacteria distribution； Drug resistance

重症加强治疗病房（ICU）是医院集中监护和救治重症患者的专业科室[1]，患者往往合并多种基础疾病，出现多器官功能障碍，免疫功能低下，加之气管插管，中心静脉导管等治疗侵入性操作损伤多种生理屏障，使得重症感染的发生率远高于其他临床科室，成为导致ICU患者病情加重及死亡的主要原因之一。由……