梁美春, 王瑶琴, 张小姣. 同一医院不同ICU病区患者痰中细菌学的分布与耐药性比较[J]. 疾病监测, 2018, 33(4): 333-338. DOI: 10.3784/j.issn.1003-9961.2018.04.017
引用本文: 梁美春, 王瑶琴, 张小姣. 同一医院不同ICU病区患者痰中细菌学的分布与耐药性比较[J]. 疾病监测, 2018, 33(4): 333-338. DOI: 10.3784/j.issn.1003-9961.2018.04.017
Liang Meichun, Wang Yaoqin, Zhang Xiaojiao. Comparison of distribution and drug resistance of bacteria in sputum culture in different ICU wards of same hospital[J]. Disease Surveillance, 2018, 33(4): 333-338. DOI: 10.3784/j.issn.1003-9961.2018.04.017
Citation: Liang Meichun, Wang Yaoqin, Zhang Xiaojiao. Comparison of distribution and drug resistance of bacteria in sputum culture in different ICU wards of same hospital[J]. Disease Surveillance, 2018, 33(4): 333-338. DOI: 10.3784/j.issn.1003-9961.2018.04.017

同一医院不同ICU病区患者痰中细菌学的分布与耐药性比较

Comparison of distribution and drug resistance of bacteria in sputum culture in different ICU wards of same hospital

  • 摘要: 目的 通过比较不同重症监护室(ICU)病区患者痰培养所获得的细菌分布及耐药性,为临床抗感染治疗和耐药监测数据提供依据。方法 将本院不同ICU病区的患者分成神经内科重症监护室组(NICU组)、内科重症监护室组(MICU组)和急诊内科重症监护室组(EICU组),采集患者痰标本,经培养获得菌株,回顾分析菌株的细菌分布和耐药性。结果 NICU组共分离出30种病原菌,MICU组共分离出39种病原菌,EICU组共分离出23种病原菌。ICU感染的病原菌以革兰阴性杆菌为主,感染前3位的细菌分别为铜绿假单胞菌、肺炎克雷伯菌和鲍曼不动杆菌。药敏结果显示,铜绿假单胞菌对阿莫西林/克拉维酸、氨曲南、头孢吡肟、头孢他啶、替加环素、哌拉西林/他唑巴坦、哌拉西林的耐药率组间比较差异有统计学意义(χ2=7.501、14.276、33.888、6.172、10.498、47.291、9.389,均P<0.05),其中MICU组铜绿假单胞菌对亚胺培南、美洛培南的耐药率均高于其余两组,其组间比较差异有统计学意义(χ2=20.573、23.081,均P=0.001)。ICU肺炎克雷伯菌对氨曲南、头孢哌酮/舒巴坦、亚胺培南、头孢他啶的耐药率组间比较差异均有统计学意义。ICU鲍曼不动杆菌对阿米卡星、复方新诺明、替加环素、妥布霉素的耐药率组间比较均差异无统计学意义,对其他抗生素的耐药率组内比较则均差异有统计学意义(P<0.05)。结论 ICU铜绿假单胞菌、鲍曼不动杆菌对常用抗生素呈现多重耐药,肺炎克雷伯菌虽然耐药性普遍较低,但却检出了多株多重耐药甚至全耐药的超级细菌。重视痰培养和耐药监测数据,真正实现从经验治疗过渡到目标治疗,实现抗感染的精准治疗。

     

    Abstract: Objective To compare the distribution and drug resistance of bacteria detected in sputum culture in different ICU wards in our hospital,and provide evidence for clinical infection treatment and drug resistance monitoring. Methods The patients from different ICU wards in our hospital were divided into 3 groups,the first group consisted of the patients in neurology department,the second group consisted of the patients in internal medicine department and the third group consisted of the patients in emergency room of internal medicine. The distribution and drug resistance of bacteria detected in sputum culture of the patients in 3 groups were analyzed retrospectively. Results A total of 30 kinds of pathogens were isolated in the first group, 39 kinds of pathogens in the second group and 23 kinds of pathogens in the third group. The pathogens were mainly gram negative bacilli,the first 3 pathogens were Pseudomonas aeruginosa,Klebsiella pneumoniae and Acinetobacter baumannii. Drug susceptibility test showed that the differences in overall drug resistance rate of P. aeruginosa to amoxicillin/clavulanic acid, aztreonam,cefepime,ceftazidime,tigecycline,piperacillin/tazobactam and piperacillin were significant among three groups (P<0.05),and the resistant rates to imipenem and meropenem were higher in the second group than those in other two groups, the differences were significant (P=0.001). The differences in overall drug resistance of K. pneumoniae to aztreonam, cefoperazone/sulbactam,imipenem and ceftazidime were significant among three groups. The differences in overall drug resistance of A. baumannii.to amikacin,cotrimoxazole,tigecycline and tobramycin were not significant among three groups,but the differences in drug resistance to other antibiotics were significant in each group(P<0.05). Conclusion Pseudomonas aeruginosa, and A. baumannii detected in different ICU wards were multi drug resistant, the drug resistant rate of K. pneumoniae was lower,but some K. pneumoniae strains were multi-drug resistant or all drug resistant. It is necessary to pay attention to sputum culture and drug resistance monitoring,conduct targeted treatment instead of empirical treatment for the accurate treatment of infection.

     

/

返回文章
返回