中国临床药学杂志

目的分析南京某三甲医院老年科ICU病原菌分布及耐药性情况,为临床合理使用抗菌药物提供参考。方法对2017年7月至2020年6月在老年科ICU发现的病原菌进行回顾性分析。结果 944株病原菌中,革兰阴性菌604株(64.0%),革兰阳性菌193株(20.4%),真菌147株(15.6%)。所有分离菌中居前3位的分别为鲍曼不动杆菌、肺炎克雷伯菌和铜绿假单胞菌。鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为63.3%和62.5%,在被测试的其他药物中以阿米卡星耐药率最低,为47.2%;铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为24.8%和20.6%;大肠埃希菌对亚胺培南和美罗培南的耐药率显著低于肺炎克雷伯菌,分别为2.3%和1.8%;金黄色葡萄球菌中甲氧西林耐药菌株的检出率为63.4%,表皮葡萄球菌中甲氧西林耐药菌株的检出率为61.1%,未发现有耐万古霉素和利奈唑胺的葡萄球菌属;粪场球菌和屎肠球菌对万古霉素、利奈唑胺都很敏感,检测出4株耐万古霉素的屎肠球菌。结论老年科ICU主要病原菌以革兰阴性菌为主,对常用抗菌药物耐药率较高,以鲍曼不动杆菌最为显著,因此应根据病原菌耐药情况合理选择抗菌药物以提高感染治愈率和遏制病原菌快速耐药的发生。

AIM To analyze the distribution and drug resistance of pathogens in ICU of geriatric department in our hospital, so as to provide reference for clinical rational use of antibacterial drugs. METHODS A retrospective analysis of pathogenic bacteria in the ICU of geriatrics from July 2017 to June 2020 was performed. RESULTS Among 944 pathogens, 604(64.0%) gram-negative bacteria, 193(20.4%) gram-positive bacteria and 147(15.6%) fungi were found.The top three isolates were Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. The resistance rates of Acinetobacter baumannii to imipenem and meropenem were 63.3% and 62.5%, respectively. Among the other drugs tested, the resistance rate of amikacin was the lowest at 47.2%. The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 24.8% and 20.6%, respectively, the resistance rates of Escherichia coli to imipenem and meropenem were significantly lower than those of Klebsiella pneumonia, which were 2.3% and 1.8% respectively. The detection rate of methicillin-resistant strains in Staphylococcus aureus was 63.4%, and the detection rate of methicillinresistant strains in Staphylococcus epidermidis was 61.1%. Staphylococcus resistant to vancomycin and linezolid was not found. Coccus faecalis and Enterococcus faecium were very sensitive to vancomycin and linezolid. Four strains of Enterococcus faecium resistant to vancomycin were detected. CONCLUSION The main pathogens in the ICU of our hospital were mainly gram-negative bacteria, and the resistance rate to commonly used antibacterial drugs was relatively high. Acinetobacter baumannii was the most significant. Antibacterial drugs should be rationally selected according to the resistance of pathogens to improve the cure rate of infection and curb the occurrence of rapid drug resistance of pathogenic bacteria.