2019 年第 11 期 第 14 卷

医院2014—2017年重症医学科住院患者主要细菌耐药情况分析

Drug resistance of main bacteria in hospitalized patients in intensive care unit from 2014 to 2017

作者：左小淑周晨亮

英文作者：

单位：430060武汉大学人民医院重症医学科

英文单位：

关键词：耐药性；重症医学科；细菌；抗菌药物

英文关键词：

• 摘要：

• 【摘要】目的    分析医院2014—2017年重症医学科住院患者主要细菌耐药情况。方法    收集2014年1月至2017年12月武汉大学人民医院重症医学科送检标本的细菌学和药敏结果，分为两阶段（2014—2015年加强抗菌药物分级管理前为Ⅰ阶段，2016—2017年加强抗菌药物分级管理后为Ⅱ阶段），进行主要细菌分布和抗菌药物耐药率变迁的分析。结果    2014—2017年重症医学科送检标本共分离出非重复临床分离株4 102株，排在前5位的细菌依次为鲍曼不动杆菌761株(18.6%)、肺炎克雷伯菌432株(10.5%)、铜绿假单胞菌343株(8.4%)、金黄色葡萄球菌327株(7.9%)、大肠埃希菌318株(7.7%)，其他1 921株(46.8%)。鲍曼不动杆菌Ⅱ阶段对阿米卡星、庆大霉素、左氧氟沙星的耐药率低于Ⅰ阶段(均P<0.05)。Ⅱ阶段肺炎克雷伯菌除了对头孢唑林的耐药率低于Ⅰ阶段（52.9%比84.4%）(P<0.05)外，对其他多种抗菌药物耐药率均较Ⅰ阶段升高(均P<0.05)。铜绿假单胞菌Ⅱ阶段对阿米卡星、庆大霉素的耐药率低于Ⅰ阶段(均P<0.001)。金黄色葡萄球菌Ⅱ阶段对青霉素类、红霉素、头孢西丁、克林霉素、环丙沙星的耐药率低于Ⅰ阶段(均P<0.001)。大肠埃希菌Ⅱ阶段对氨苄西林、氨苄西林/舒巴坦、头孢唑林、头孢他啶、头孢噻肟、头孢吡肟、阿米卡星、庆大霉素、环丙沙星、复方新诺明的耐药率均低于Ⅰ阶段(均P<0.05)。结论    重症医学科分离的主要细菌仍以革兰阴性菌为主，其耐药形式较严峻，定期监控重症医学科主要细菌的分离率和耐药率变化是合理选择抗菌药物的前提。

• 【Abstract】Objective    To analyze the main bacterial resistance in hospitalized patients in intensive care unit from 2014 to 2017. Methods    Bacteriology and drug susceptibility results of specimens separated from patients in intensive care unit of Renmin Hospital of Wuhan University were collected. Intervention measures on classification management for antibacterials were performed since 2016. Main bacterial distribution and resistance rates to common antibacterials were analyzed between 2014-2015（stage Ⅰ） and 2016-2017（stage Ⅱ）. Results    From 2014 to 2017, 4 102 strains of bacteria were isolated from intensive care unit. The top 5 bacteria were Acinetobacter baumannii［761(18.6%)］, Klebsiella pneumoniae［432(10.5%)］, Pseudomonas aeruginosa［343(8.4%)］, Staphylococcus aureus［327(7.9%)］ and Escherichia coli［318(7.7%)］; other strains accounted for 1 921(46.8%). Resistance rates of Acinetobacter baumannii to amikacin, gentamicin and levofloxacin at stage Ⅱ were lower than those at stage Ⅰ(all P<0.05). Resistance rate of Klebsiella pneumoniae to cefazolin decreased during stage Ⅱ（52.9% vs 84.4% at stage Ⅰ） while the resistance rates to other antibiotics were higher than those at stage Ⅰ(all P<0.05). Resistance rates of Pseudomonas aeruginosa to amikacin and gentamicin at stage Ⅱ were lower than those at stage Ⅰ(both P<0.001). Resistance rates of Staphylococcus aureus to penicillin, erythromycin, cefoxitin, clindamycin and ciprofloxacin at stage Ⅱ were lower than those at stage Ⅰ(all P<0.001). Resistance rates of Escherichia coli to ampicillin, ampicillin/sulbactam, cefazolin, ceftazidime, cefotaxime, cefepime, amikacin, gentamicin, ciprofloxacin and compound neotamine at stage Ⅱ were lower than those at stage Ⅰ(all P<0.05). Conclusions    Gram-negative bacteria are the main bacteria isolated from intensive care unit and drug resistance is prevalent. Regular monitoring of the isolation rate and drug resistance rate of main bacteria is the premise of rational use of antibiotics.