2009—2013年某院重症监护病房常见细菌及耐药变迁
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邱隆敏

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R181.3+2

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贵州省卫生计生委科学技术基金项目(gzwjkj2014-1-070)


Common bacteria and change in antimicrobial resistance in the intensive care unit of a hospital from 2009 to 2013
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    摘要:

    目的了解重症监护病房(ICU)近5年检出的常见细菌及其耐药性变迁,为临床合理用药提供依据。方法收集某三甲医院2009—2013年ICU患者送检标本分离的细菌,对其进行鉴定及药物敏感试验。结果2009—2013年ICU共分离细菌1 196株,居前5位的细菌为鲍曼不动杆菌、铜绿假单胞菌、金黄色葡萄球菌、大肠埃希菌、肺炎克雷伯菌,分别占29.60%、14.38%、12.21%、12.21%、11.37%。2009—2013年金黄色葡萄球菌对苯唑西林、庆大霉素、克林霉素、环丙沙星和利福平耐药率呈逐年下降趋势(均P<0.05), 5年未出现对万古霉素耐药的菌株;铜绿假单胞菌对头孢他啶、头孢吡肟、氨曲南、庆大霉素、阿米卡星、妥布霉素和哌拉西林/他唑巴坦的耐药率呈下降趋势(均P<0.05),2009—2012年亚胺培南耐药率为32.26%~46.43%,2013年为16.00%;鲍曼不动杆菌对阿米卡星、妥布霉素和复方磺胺甲口恶唑的耐药率均呈下降趋势(均P<0.05), 2009—2011年阿米卡星耐药率均>80%,2013年则为10.53%,5年间鲍曼不动杆菌对大部分抗菌药物具有较高的耐药性(耐药率>80%)。2009—2013年肺炎克雷伯菌、大肠埃希菌对哌拉西林/他唑巴坦、头孢唑林、头孢吡肟、阿米卡星和氨曲南等的耐药率呈下降趋势(均P<0.05)。结论该院ICU常见感染细菌对部分抗菌药物耐药性呈下降趋势,可能与国家政策的出台和医院的管理有关, 建议继续加强抗菌药物管理,合理使用抗菌药物,防止细菌耐药性增加。

    Abstract:

    ObjectiveTo investigate the common bacteria and change in antimicrobial resistance in an intensive care unit (ICU) in the past 5 years, and provide evidence for rational use of antimicrobial agents.MethodsBacteria isolated from ICU patients in a tertiary firstclass hospital from 2009 to 2013 were collected, identified, and performed antimicrobial susceptibility testing.ResultsA total of 1 196 bacteria isolates were isolated in 2009-2013, the top five species were Acinetobacter baumannii (A. baumannii, 29.60%), Pseudomonas aeruginosa (P. aeruginosa, 14.38%), Staphylococcus aureus (S. aureus, 12.21%), Escherichia coli(E. coli, 12.21%), and Klebsiella pneumoniae(K. pneumoniae, 11.37%). Resistance rates of S. aureus to oxacillin, gentamycin, clindamycim, ciprofloxacin, and rifampicin showed a decreasing tendency from 2009 to 2013(all P<0.05), and no strain was detected to be resistant to vancomycin during 5 years. Resistance rates of P. aeruginosa to ceftazidime, cefepime, aztreonam, gentamycin, amikacin, tobramycin, and piperacillin/tazobactam decreased gradually (all P<0.05), imipenem resistance rates were 32.26%-46.43% in 2009-2012 and 16.00% in 2013; A. baumannii  maintained a low level resistance to amikacin, tobramycin, and compound sulfamethoxazole(all P<0.05),resistance rates to imipenem were all >80% in 2009-2011 and 10.53% in 2013, A. baumannii had high resistance rates to most antimicrobial agents(resistance rates were >80%) during 5 years. Resistance rates of K. pneumoniae  and E. coli to piperacillin/tazobactam, cefazolin, cefepime, amikacin, and  aztreonam had a decreased tendency in 2009-2013(all P<0.05).ConclusionThe common bacteria causing infection in the ICU of this hospital showed a downward trend, which may be related to the introduction of national policies and management of hospital, continuous management of antimicrobial agents is suggested, antimicrobial agents should be used rationally to prevent the increase of bacterial resistance.

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龙盛双,胡潇云,张啟鹏,等.2009—2013年某院重症监护病房常见细菌及耐药变迁[J]. 中国感染控制杂志,2016,15(8):542-547. DOI:10.3969/j. issn.1671-9638.2016.08.002.
LONG Shengshuang, HU Xiaoyun, ZHANG Qipeng, et al. Common bacteria and change in antimicrobial resistance in the intensive care unit of a hospital from 2009 to 2013[J]. Chin J Infect Control, 2016,15(8):542-547. DOI:10.3969/j. issn.1671-9638.2016.08.002.

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  • 收稿日期:2015-11-18
  • 最后修改日期:2016-02-23
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  • 在线发布日期: 2016-08-18
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