摘要
目的分析威海地区重症加强治疗病房(ICU)与非ICU呼吸道革兰阴性(G-)菌的分布特点及耐药性,辅助临床制定合理的用药方案。方法收集2017年10月1日—2018年9月30日威海市细菌监测网8家教学医院3 620株呼吸道来源G-菌,按照统一方案进行细菌耐药性监测,采用纸片扩散法(K-B法)、自动化仪器法和E试验法进行药敏试验,按照美国临床实验室标准化协会(CLSI)2017年版标准判读结果,应用Whonet 5.6软件统计分析呼吸道标本分离菌的分布及耐药性。结果 8家医院共检出3 620株G-菌,其中ICU有665株(占18.37%),非ICU有2 955株(占81.63%);ICU与非ICU呼吸道标本分离的G-杆菌均以肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌3种类型为主,具有广泛耐药性。来自ICU和非ICU的肺炎克雷伯菌对氨苄西林/舒巴坦和头孢曲松的耐药率均在30%以上,但对阿米卡星、亚胺培南和美罗培南的耐药率均相对较低;来自ICU和非ICU的鲍曼不动杆菌对亚胺培南的耐药率分别为61.6%、52.0%,未检出对替加环素和多黏菌素的耐药株;来自ICU和非ICU的铜绿假单胞菌对亚胺培南的耐药率分别为13.6%、10.3%。结论 ICU G-菌感染发生率高且耐药广泛。临床应根据患者病原菌的耐药情况合理选用抗菌药物,实施针对性治疗,提高治疗效果。
Objective To analyze the distribution characteristics and drug resistance of respiratory gramnegative(G-) bacteria in intensive care unit(ICU) and non-ICU in Weihai area, and to assist clinical development of rational application of drug regimen. Methods From October 1, 2017 to September 30, 2018, 3 620 strains of bacteria from respiratory source in 8 Weihai bacteria monitoring network teaching hospitals were collected, and according to the unified method, the bacterial drug resistance surveillance was carried out;the paper disc diffusion method(K-B method), automatic instrument and E test method were used to perform drug sensitive tests, according to the standards in 2017 Edition of American Clinical Laboratory Standardization Institute(CLSI), the results were interpreted, and Whonet 5.6 software was applied to statistically analyze the distribution and drug resistance of the bacteria isolated from the respiratory tract specimens. Results A total of 3 620 gram negative strains of bacteria were detected from 8 hospitals, including 665 strains from ICU(18.37%) and 2 955 strains from non-ICU(81.63%;the G-bacilli isolated from both ICU and non-ICU respiratory tract specimens were dominated by Acinetobacter baumanni, Klebsiela pneumoniae and Pseudomonas aeruginosa, and their drug resistances were extensive. The drug resistance rates of Klebsiella pneumoniae from ICU and non-ICU to ampicillin/sulbactam and ceftriaxone were above30%, but the rates to amikacin, imipenem and meropenem were relatively low;the drug resistance rates of Acinetobacter baumannii from ICU and non-ICU to imipenem were 61.6%, 52.1% respectively and there was no strain resistance to tegacycline and polymyxin;the drug resistance rates of Pseudomonas aeruginosa from ICU and non-ICU to imipenem were 13.6% and 10.3%, respectively. Conclusion The incidence of ICU G-bacteria infection is high, and the drug resistance is extensive, so it is necessary to select appropriate antimicrobial agents according to the patient’s pathogen resistance, and carry out targeted treatment to improve the therapeutic effect.
作者
刘海珠
李进红
徐静
孙梅
王颖
Liu Haizhu;Li Jinhong;Xu Jing;Sun Mei;Wang Ying(Centralab,Weihai Municipal Hospital,Weihai 264200,Shandong,China;Department of Endocrinology,Weihai Municipal Hospital,Weihdi 264200,Shandong,China;Department of Laboratory,Weihai Maternal and Child Health Hospital,Weihai 264400,Shandong,China;Department of Laboratory,Weihai Rongcheng Center Hospital,Weihai 264400,Shandong,China)
出处
《实用检验医师杂志》
2019年第1期15-18,共4页
Chinese Journal of Clinical Pathologist
基金
山东省保健科技协会科学技术课题(SDBJKT20180035)~~
关键词
呼吸道感染
病原菌
耐药性
重症加强治疗病房
监测
Respiratory tract infection: Pathogenic Bacteria
Drug resistance: Intensive care unit: Monitoring
