华西医院重症监护病房连续两年院内感染革兰阴性杆菌耐药性监测.docVIP

华西医院重症监护病房连续两年院内感染革兰阴性杆菌耐药性监测 　 作者：郑沁 赖怡 康梅 过孝静 陈知行 简君 【摘要】 目的 调查分析我院重症监护病房(ICU)医院感染革兰阴性杆菌的菌群分布和耐药现状及耐药变迁，指导临床合理使用抗生素。方法 采用Etest药敏试验测定我院重症监护病房连续两年分离的200株院内感染革兰阴性杆菌对12种抗生素的最低抑菌浓度(MIC)。结果 ICU病房分离率最高的院内感染革兰阴性杆菌依次为大肠埃希菌(34%)，不动杆菌属细菌(18%)，铜绿假单胞菌(15.5%)，克雷伯菌属细菌(15.5%)，肠杆菌属细菌(13%)；两年中总耐药率最低的是亚胺培南；呼吸道标本中最常见的为不动杆菌属细菌(23%)，铜绿假单胞菌(18.7%)，克雷伯菌属细菌(18.7%)，大肠埃希菌(17%)；尿标本中主要分离菌为大肠埃希菌(81%)；血液标本中主要分离菌为大肠埃希菌(73%)。呼吸道标本中，2004年铜绿假单胞菌的分离率25%明显高于2003年1.4%；大肠埃希菌和肺炎克雷伯菌超广谱β内酰胺酶(ESBLs)的发生率从2003年的47%和35.7%升高到2004年的50%和53%。结论 亚胺培南对大肠埃希菌和肠杆菌属细菌均保持很高的敏感性，铜绿假单胞菌对头孢他啶和阿米卡星的敏感性最高，不动杆菌属细菌对头孢哌酮/舒巴坦、亚胺培南的敏感性最高，但对亚胺培南的耐药率呈上升趋势。因此，进行本医院、本地区的细菌耐药动态监测对指导临床抗感染经验用药是非常必要的。 【关键词】 耐药性； 革兰阴性杆菌； ICU； 医院感染； ESBLs ABSTRACT Objective To investigate the distribution and resistant rate of Gramnegative bacilli isolated from intensive care units (ICU) of West China Hospital in two years. Method Etest was used to detect the minimal inhibition concentration (MIC) of 200 Gramnegative bacilli isolated from ICU of West China Hospital. Results The most common pathogens were Escherichia coli (34%), Acinetobacter spp. (18%), Pseudomonas aeruginosa (18.7%) and Enterobacter spp. (17%). Of 12 antibiotics,the resistant rate of imipenem was the lowest. The most common pathogens in respiratory tract specimens were Acinetobacter spp. (23%), Pseudomonas aeruginosa (18.7%), Klebsiella. spp. (18.7%) and Escherichia coli (17%); in urine specimens it was Escherichia coli (81%); in blood specimens it was Escherichia coli (73%). In respiratory tract, the isolated rate of Pseudomonas aeruginosa in 2004 (25%) was notablely higher than that in 2003 (1.4%). The prevalence of extended spectrum βlactamases in Escherichia coli and Klebsiella pneumoniae were increased from 47% and 35.7% in 2003 to 50% and 53% in 2004. Conclusion Imipenem remained highly active against Escherichia coli and Enterobacter spp.; ceftazidime and amikacin had the strongest antibacterial activity against Pseudomonas aeruginosa; cefopreazone/sulbactam and imipenem h