摘要目的 了解2013年至2017年本院重症医学科临床细菌分离株耐药情况,为合理使用抗菌药物提供依据.方法 采用Vitek-2 Compact全自动微生物分析系统进行细菌鉴定,采用自动化仪器法结合纸片扩散法进行药敏试验,使用WHONET 5.6软件进行数据统计分析,药敏结果判断标准参照CLSI M100-S27th版.结果 2013年至2017年本院重症医学科送检的4 980份标本中分离到1 049株细菌,其中革兰阳性菌331株(31.6％),革兰阴性菌718株(68.4％).耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为84.5％和80.2％,未发现万古霉素及利奈唑胺耐药的葡萄球菌.粪肠球菌耐药率低于屎肠球菌,其中屎肠球菌检出1株万古霉素耐药株,根据PCR测序为vanM基因型.肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌对碳青酶烯类耐药率分别为50.7％、50.4％、82.7％.结论 重症医学科细菌耐药情况较为严重,需加强病原菌检测及耐药性监测,合理使用抗菌药物,并采取有效院感防控措施.

abstractsObjective To analyze the distribution and antibiotic resistance of the clinical bacterial isolated from the intensive care unit (ICU) of Tongren Hospital during 2013-2017.Methods All the bacterial isolates were identified by Vitek-2 Compact system.Antimicrobial susceptibility testing was carried out using Kirby-Bauer method or automated systems.The susceptibility data were analyzed using WHONET 5.6 software.Results were interpreted according to CLSI M100-S27th breakpoints.Results A total of 1 049 clinical isolates were collected,including 331 (31.6％) strains of gram positive bacteria and 718 (68.4％) strains of gram negative bacteria.The overall prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in Staphylococcus aureus and methicillin resistant coagulase negative staphylococci (MRC-NS) in coagulase-negative Staphylococcus were 84.5％ and 80.2％.No Staphylococcus strains were found resistant to vancomycin or linezolid.The resistance rates of E.faecalis strains to most drugs tested were lower than those of E.faecium.Polymerase chain reaction (PCR) amplification and sequencing analysis indicated that the only one vancomycin-resistant strains isolated from E.faecium was vanM type.The resistance rates to carbapenems of Klebsiella pneumoniae,Pseudomonas aeruginosa,and Acinetobacter baumannii respectively were 50.7％,50.4％,and 82.7％.Conclusions Antibiotic resistance is still very serious in ICU.It is necessary to maintain good practice in surveillance of bacterial resistance,and strengthen management of clinical use of antimicrobial agents and hospital infection control.