摘要
目的分析三级甲等医院重症加强治疗病房（ICU）连续7年非发酵菌感染的分布特点及其耐药情况，为指导ICU合理应用抗菌药物提供依据。方法采用回顾性分析方法，选择2009年1月至2015年12月山东省滨州医学院附属医院ICU住院患者，收集从下呼吸道、血、尿、胆汁、分泌物等标本中分离出非发酵菌的相关资料，分析非发酵菌感染的分布特点和耐药情况以及多重耐药（MDR）菌株的分离率。结果7年间共分离出非发酵菌2672株，占革兰阴性（G-）杆菌的57．9％（2672／4613），占所有分离菌株的35．2％（2672／7587）；其中居于前5位的非发酵菌分别为鲍曼不动杆菌（38．4％）、铜绿假单胞菌（34．6％）、洋葱伯克霍尔德菌（9．9％）、嗜麦芽窄食单胞菌（6．2％）和荧光假单胞菌（5．6％）；非发酵菌主要来源于下呼吸道（60．9％）。7年间每年非发酵菌均占G-杆菌的50％以上，各年度前5位菌种无明显变化，其中鲍曼不动杆菌上升趋势明显（从2009年的26．5％升至2015年的50．2％），洋葱伯克霍尔德菌、嗜麦芽窄食单胞菌及荧光假单胞菌呈下降趋势（分别从2009年的15．6％、10．6％和13．0％降至2015年的5．6％、7．4％和1．4％），而铜绿假单胞菌变化趋势不明显，7年间始终保持在30％左右。药敏结果显示，2009年至2015年鲍曼不动杆菌对亚胺培南，西司他丁、美罗培南、氨基糖苷类及三代头孢菌素均保持在约70％的高耐药率，而对头孢哌酮／舒巴坦保持稳定的低耐药率（40．2％～68．1％）及相对较高的敏感率（23．6％～46．0％）。铜绿假单胞菌对抗菌药物的耐药率相对较低，对四代头孢菌素头孢吡肟（58．3％-87．7％）及三代头孢菌素始终保持较高的敏感率（头孢他啶为55．6％-79．3％，哌拉西林／他唑巴坦为62．5％～86．2％，头孢哌酮／舒巴坦为46．0％～89．8％）。从2009年至2015年，鲍曼不动杆菌中MDR菌株增长趋势明显（从68．2％升至84．1％）；铜绿假单胞菌中MDR菌株增长趋势不明显，且近3年呈下降趋势，从2012年峰值68．6％降至2015年23．5％。结论非发酵菌分离率居高不下，耐药形势严峻；及时了解和掌握ICU非发酵菌的分布、耐药性特征及变化特点，有利于临床合理选择抗菌药物，提高疗效并减少耐药菌株的产生。
Objective To study the distribution characteristics and drug resistance of non-fermenting bacterial infection in intensive care unit （ICU） at a tertiary hospital during seven consecutive years, and to provide evidence for rational use of antibiotics in ICU. Methods A retrospective analysis was conducted. The related data about non-fermentative bacteria obtained from clinical specimens, collected from lower respiratory tract, blood, urine, bile and other secretions of ICU patients admitted to Binzhou Medical University Hospital from January 2009 to December 2015 were retrospectively analyzed. The distribution characteristics and drug resistance of non-fermentative bacteria, and isolation rate of multiple drug resistance （MDR） strains were analyzed. Results 2 672 strains of non- fermentative bacteria were isolated during seven consecutive years, accounting for 57.9% gram negative （G-） bacilli （2 672/4 613）, and 35.2% of all bacteria （2 672/7 587）. The top five were Acinetobacter baumannii （38.4%）, Pseudomonas aeruginosa （34.6%）, Onion burkholderia cepacia （9.9%）, Stenotrophomonas maltophilia （6.2%）, and Pseudomonas fluorescens （5.6%）. Non-fermentative bacteria were mainly isolated from the lower respiratory tract （60.9%）. Isolation of the non-fermentative bacteria accounted for over 50% of G- bacilli during seven consecutive years, and the isolation rate of the top five types of bacteria showed no obvious change, while positive rate of Acinetobacter baumannii showed a tendency to increase （obviously from 26.5% in 2009 to 50.2% in 2015）, and a lowering trend of positive rate of Onion burkholderia cepacia, Stenotrophomonas maltophilia, and Pseudomonas fluorescens was obvious （from 15.6%, 10.6%, 13.0% in 2009 to 5.6%, 7.4%, 1.4% in 2015 respectively） was observed. The isolation rate of Pseudomonas aeruginosa was stable （about 30%） during seven consecutive years. The drug susceptibility results showed that the resistant rates of Acinetobacter baumannii against imipenem, meropenem, aminoglycosides and third-generation cephalmsporins were all higher than 70%, while its resistant rate to cefoperazone-sulbactam was relatively lower （40.2%-68.1%） with relatively higher sensitivity rate （23.6%-46.0%）. In contrast, the resistant rates of Pseudomonas aeruginosa against antibiotics were low, while the sensitivity rate to fourth-generation cephalmsporins cefepime （58.3%-87.7%） and third-generation cephalmsporins was high （ceftazidime： 55.6%-79.3%, piperacillin-tazobactam： 62.5%-86.2%, cefoperazone-sulbactam： 46.0%-89.8%）. From 2009 to 2015, the incidence of MDR strains ofAcinetobacter baumannii showed an obvious increasing tendency （from 68.0% to 84.1%）; in contrast, the incidence of MDR strains of Pseudomonas aeruginosa did not show an obviously increase in incidence from 2009 to 2012, on the other hand, it showed a decreasing tendency from a peak 68.6% in 2012 to 23.5% in 2015. Conclusions The isolation rate of non-fermentative bacteria was high and the drug resistance situation was serious. Therefore, it is important to grasp the knowledge regarding distribution characteristics, drug resistance and variation of non-fermentative bacteria in ICU. It is not only beneficial for both rational use of antibiotics, improve efficacy but also helpful in reducing the emergence of drug resistance stains.
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2016年第5期439-444,共6页
Chinese Critical Care Medicine
基金
山东省高等学校科技计划项目（J12LL06）
关键词
非发酵菌
分布特点
重症加强治疗病房
细菌耐药性
Non-fermentative bacteria
Distribution characteristics
Intensive care unit
Bacterial resistance
