中国临床药学杂志

目的分析重症监护病房(ICU)病原菌临床分布情况及耐药性,为临床合理选用抗菌药物提供依据。方法回顾性分析2018年1月至2020年12月ICU患者临床样本病原菌及其耐药性。结果共检出病原菌1 357株,主要来源于痰液(占61.46%)、尿液(占11.57%)和血液(占11.35%)三大类样本。其中革兰阳性(G⁺)菌281株,占20.71%;革兰阴性(G~-)菌1 076株,占79.29%。按病原学检出率排名,前8位的分别是肺炎克雷伯菌(23.07%)、鲍曼不动杆菌(15.11%)、铜绿假单胞菌(8.25 %)、大肠埃希菌(7.66%)、屎肠球菌(7.07%)、嗜麦芽窄食单胞菌(5.97%)、阴沟肠杆菌(5.45%)和金黄色葡萄球菌(4.57%)。3年数据显示肺炎克雷伯菌的耐药率逐年上升,肺炎克雷伯菌和大肠埃希菌对碳青霉烯类抗菌药物的敏感性不断降低;铜绿假单胞菌对左氧沙星、环丙沙星、头孢他啶等抗菌药物的的敏感度升高;未发现对利奈唑胺、万古霉素、替加环素耐药的G⁺菌。结论重症监护病房病原菌以G~-菌为主,肺炎克雷伯菌居首,耐碳青霉烯的肺炎克雷伯菌的检出率呈上升趋势。

AIM To investigate the clinical distribution and drug resistance of pathogens of the patients in intensive care unit(ICU) to provide evidence for clinically choosing antibiotics reasonably. METHODS Pathogens isolated from specimens of ICU patients from January 2018 to December 2020 were identified and drug susceptibility tests were performed. RESULTS A total of 1 357 clinical pathogens were detected which mainly came from specimens of sputum(61.46%), urine(11.57%) and blood(11.35%). Gram-positive cocci and Gram negative bacilli accounted for 20.71% and 79.29%, respectively. According to the pathogen detection rate, the top eight were Klebsiella pneumoniae(23.07%), Acinetobacter baumanii(15.11%), Pseudomonas aeruginosa(8.25%), Escherichia coli(7.66%), Enterococcus faecium(7.07%), Stenotrophomonas maltophilia(5.97%), Enterobacter cloacae(5.45%), and Staphylococcus aureus(4.57%). Combined with three-year of data, the drug resistance rate of Klebsiella pneumoniae increased year by year. The susceptibility of Klebsiella pneumoniae and Escherichia coli to carbapenems was decreasing. Pseudomonas aeruginosa showed increased sensitivity to levofloxacin, ciprofloxacin, ceftazidime and other antimicrobial agents. No linezolid-, vancomycin-or tigecycline-resistant isolates were found in Gram-positive bacteria. CONCLUSION Gram-negative is the main pathogen in ICU and Klebsiella pneumoniae is the most. The detection rate of carbapenem-resistant Klebsiella pneumoniae shows an upward trend.