切换至 "中华医学电子期刊资源库"

中华实验和临床感染病杂志(电子版) ›› 2017, Vol. 11 ›› Issue (02) : 176 -180. doi: 10.3877/cma.j.issn.1674-1358.2017.02.015

临床论著

某院2014年度重症监护病房病原菌分布及耐药性分析
罗玮1, 杨丽2, 苏维奇1, 于清华1,()   
  1. 1. 266071 青岛市,山东省青岛市市立医院检验科
    2. 266034 青岛市,山东省青岛市妇女儿童医院检验科
  • 收稿日期:2016-01-16 出版日期:2017-04-15
  • 通信作者: 于清华

Distribution and drug resistance of pathogens in intensive care unit in a hospital

Wei Luo1, Li Yang2, Weiqi Su1, Qinghua Yu1,()   

  1. 1. Department of Clinical Laboratory, Qingdao Municipal Hospital, Qingdao 266071, China
    2. Department of Clinical Laboratory, Qingdao Women and Children’s Hospital, Qingdao 266034, China
  • Received:2016-01-16 Published:2017-04-15
  • Corresponding author: Qinghua Yu
引用本文:

罗玮, 杨丽, 苏维奇, 于清华. 某院2014年度重症监护病房病原菌分布及耐药性分析[J/OL]. 中华实验和临床感染病杂志(电子版), 2017, 11(02): 176-180.

Wei Luo, Li Yang, Weiqi Su, Qinghua Yu. Distribution and drug resistance of pathogens in intensive care unit in a hospital[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2017, 11(02): 176-180.

目的

探讨重症监护病房(ICU)患者病原菌的分布特点及耐药情况。

方法

对2014年1月至2014年12月于本院ICU住院患者送检的711份标本进行细菌培养,采用BD公司Poenix-100全自动细菌鉴定/药敏系统对病原菌进行鉴定和药敏试验,根据CLSI 2013版判定结果。采用χ2检验分析ICU与其他科室鲍曼不动杆菌、肠球菌和念珠菌的耐药性。

结果

共收集363份(51.05%)痰液标本,202份(28.41%)来自血液标本,90份(12.66%)尿标本和56份(7.88%)其他标本。共分离出病原菌475株,检出最多的革兰阴性菌为鲍曼不动杆菌134株(28.21%),检出最多的革兰阳性菌为屎肠球菌22株(4.63%),检出真菌共67株(14.11%)。ICU患者鲍曼不动杆菌对多黏菌素均敏感,对多数抗菌药物的耐药率均高于其他科室(P均< 0.001)。肠球菌对利奈唑胺、替考他宁和万古霉素均敏感,对多数抗菌药物耐药率高,与其他科室差异无统计学意义。真菌对两性霉素均敏感,对沃尔康唑和氟康唑的耐药率显著高于其他科室(P均< 0.001)。

结论

ICU患者非发酵菌和真菌检出率高,且多种病原菌耐药情况较其他科室严重,需加强ICU病原菌及耐药性监测,并根据药敏试验结果合理选用抗菌药物,以减少耐药菌的产生和扩散。

Objective

To investigate the distribution and drug resistance of pathogens in intensive care unit (ICU).

Methods

Total of 711 specimens from patients in ICU from January to December in 2014 were collected for culture. Identification and antimicrobial susceptibility detection were carried out using BD Phoenix-100 automated microbiology system. The data were analyzed according to CLSI 2013 breakpoints. The differences of drug resistance of Acinetobacter baumannii, Enterococcus and Candida between ICU and other departments were analyzed by Chi-square test.

Results

Total of 363 (51.05%) sputum samples, 202 (28.41%) blood samples, 90 (12.66%) urine samples and 56 (7.88%) other samples were collected. Among the 475 clinical isolates, 134 strains of Acinetobacter baumannii (28.21%) were detected, which was the most common Gram-negative bacterium, 22 strains of Enterococcus faecium (4.63%) were detected, which was the most common gram-positive bacterium, and 67 strains of fungi (14.11%) were detected. Acinetobacter baumannii detected from ICU was absolutely susceptible to polymyxin, which had higher resistant rates to most antibiotics than isolates from other departments (all P < 0.001). Enterococcus was absolutely susceptible to linezoid, teicoplanin and vancomycin, which had higher resistant rates to most antibiotics and had no significant difference compared with isolates form other departments. The fungus was absolutely susceptible to amphotericin and had higher resistant rates to voriconazole and fluconazole than isolates from other departments (all P < 0.001).

Conclusions

The detection rates of non-fermentative bacteria and fungi from ICU patients were high. The antibiotics resistance of several pathogens from ICU was more serious than that from other departments. So monitoring of distribution and drug resistance of pathogens should be strengthened and antibiotics should be used rationally in order to reduce the development and spread of drug-resistant bacteria.

表1 所收集标本类型构成比及阳性率
表2 所分离病原菌分布及构成比
表3 ICU与其他科室鲍曼不动杆菌对临床常用药物的耐药性
表4 ICU与其他科室肠球菌对临床常用药物的耐药性
表5 ICU及其他科室分离的真菌对临床常用药物的耐药性
1
叶应妩,王毓三,申子瑜主编. 全国临床检验操作规程[M]. 3版. 南京:东南大学出版社,2015.
2
Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing[S]. Twenty-Third Informational Supplement,2013. [M100-S23].
3
李宝珍,平宝华,赵丽萍. 重症监护室医院感染及其危险因素研究[J]. 中国感染控制杂志,2010,9(6):426-428.
4
胡付品,朱德妹,汪复, 等. 2013年中国CHINET细菌耐药性监测[J]. 中国感染与化疗杂志,2014,14(5):365-374.
5
朱任媛,张小江,杨启文, 等. 卫生部全国细菌耐药监测网2011年ICU来源细菌耐药监测[J]. 中国临床药理学杂志,2012,12(28):905-909.
6
贾育红,袁天柱,刘滨. 重症监护室医院下呼吸道感染常见非发酵菌的耐药性与危险因素[J]. 中国感染控制杂志,2012,11(2):104-108.
7
Ying Q, Qun L, Qinzhong L, et al. Investigation and control of a suspected nosocomial outbreak of pan-drug resistant Acinetobacter baumannii in an intensive care unit[J]. Open Med(Wars),2016,11(1):587-592.
8
Hackel MA, Badal RE, Bouchillon SK, et al. Resistance rates of intra-abdominal isolates from intensive care units and non-intensive care units in the United States: the study for monitoring antimicrobial resistance trends 2010-2012[J]. Surg Infect(Larchmt),2015,16(3):298-304.
9
Bianco A, Quirino A, Giordano M, et al. Control of carbapenem-resistant Acinetobacter baumannii outbreak in an intensive care unit of a teaching hospital in Southern Italy[J]. BMC Infect Dis,2016,16(1):747.
10
李琳. 不同时间段临床分离的鲍曼不动杆菌的耐药性及分布[J/CD]. 中华实验和临床感染病杂志(电子版),2014,8(5):687-689.
11
Necati Hakyemez I, Kucukbayrak A, Tas T, et al. Nosocomial Acinetobacter baumannii infections and changing antibiotic resistance[J]. Pak J Med Sci,2013,29(5):1245-1248.
12
Ager S, Gould K. Clinical update on linezolid in the treatment of Gram-positive bacterial infections[J]. Infect Drug Resist,2012,5(1):87-102.
13
Chong YP, Park SJ, Kim HS, et al. Persistent Staphylococcus aureus bacteremia: a prospective analysis of risk factors, outcomes, and microbiologic and genotypic characteristics of isolates[J]. Medicine,2013,92(2):98-108.
14
Mamishi S, Moradkhani S, Mahmoudi S, et al. Penicillin-resistant trend of Steptococcus pneumoniae in Asia: a systematic review[J]. Iran J Microbiol,2014,6(4):198-210.
15
Safa L, Afif N, Zied H, et al. Proper use of anti-biotics: situation of linezolid at the intensive care unit of the Tunisian Military Hospital[J]. Pan Afr Med J,2016,28(25):196.
16
Guillard P, de La Blanchardiere A, Cattoir V, et al. Antimicrobial stewardship and linezolid[J]. Int J Clin Pharm,2014, 36(5):1059-1068
17
Kriengkauykiat J, Ito JI, Dadwal SS. Epidemiology and treatment approaches in management of invasive fungal infections[J]. Clin Epidemiol,2011,3:175-191.
18
Arens C, Bernhard M, Koch C, et al. Strategies for antifungal treatment failure in intensive care units[J]. Anaesthesist,2015,64(9):643-658.
19
Singh S, Fatima Z, Hameed S. Predisposing factors endorsing Candida infections[J]. Infez Med,2015,23(3):211-223.
20
Orasch C, Marchetti O, Garbino J, et al. Candida species distribution and antifungal susceptibility testing according to European Committee on Antimicrobial Susceptibility Testing and new vs. old Clinical and a Laboratory Standards Institute clinical breakpoints: a 6-year prospective candidaemia survey from the fungal infection network of Switzerlan[J]. Clin Microbiol Infect,2014,20(7):698-705.
[1] 袁丹, 钟潇, 王明松, 贾康. 脊髓损伤神经源性膀胱患者间歇导尿期间尿路感染病原菌分布及影响因素[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(04): 229-236.
[2] 朱琳, 陈韬, 张慎, 许东. 华中地区某三甲医院感染科近十年病原菌结构及耐药性变迁[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(02): 75-82.
[3] 袁柳凤, 徐文绮, 朱小宇, 王慧珠, 伦文辉. 283株淋球菌对七种常见抗菌药物的耐药性分析[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(02): 108-112.
[4] 韦涌涛, 王松霞, 苏爱美, 王东平. 耐碳青霉烯类铜绿假单胞菌耐药性及联合药敏试验研究[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(01): 43-48.
[5] 毛建. 老年糖尿病患者社区获得性肺炎病原分布及空腹血糖、糖化血红蛋白的预测价值[J/OL]. 中华实验和临床感染病杂志(电子版), 2023, 17(06): 408-415.
[6] 陈浩, 王萌. 胃印戒细胞癌的临床病理特征及治疗选择的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 108-111.
[7] 巨春蓉, 门同义, 薛武军. 实体器官移植后难治性/耐药性巨细胞病毒感染诊疗进展[J/OL]. 中华移植杂志(电子版), 2024, 18(02): 86-92.
[8] 方道成, 王勇, 胡媛媛. 泌尿系结石患者尿液菌谱及药敏特点分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(01): 64-68.
[9] 王晓丹, 王媛, 崔向宇, 任晓磊. 上尿路结石内镜手术后尿源性脓毒血症病原菌耐药及死亡高危因素分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 611-615.
[10] 邢嘉翌, 龚佳晟, 祝佳佳, 陆群. 肺癌化疗患者继发肺部感染的病原菌耐药性及炎症因子变化分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 714-718.
[11] 杨慧, 郭丽娟, 冯晓丹, 李静, 黄成谋, 蔡兴锐, 覃英娇, 王远礼. 非小细胞肺癌铂类药物耐药mi RNA表达特征及预测分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 719-724.
[12] 李跃, 万玉峰, 何远强, 伏冉, 郑玉龙. 慢性共病患者并发医院获得性肺炎的病原菌分布及影响因素分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(03): 446-449.
[13] 王蕊, 林先萍, 李盼盼. 铜绿假单胞菌感染肺炎菌血症危险因素及耐药性分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(03): 478-480.
[14] 蔡小芳, 高慧, 葛军, 邢慧芸, 庄小燕, 李小丁. 多重耐药性肺结核治疗依从性预测分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(01): 51-56.
[15] 张雯雯, 雷文静, 宋鑫, 董魁, 王文革. 眼科术后感染性眼内炎影响因素及其病原学分析的临床研究[J/OL]. 中华眼科医学杂志(电子版), 2024, 14(02): 83-89.
阅读次数
全文


摘要