2015—2017年北京怀柔医院呼吸科重症监护病房感染性疾病病原菌分布及耐药性分析

目的 探究2015-2017年北京怀柔医院呼吸科重症监护病房（RICU）感染性疾病病原菌分布及耐药性，为临床合理选用抗菌药物及有效控制感染提供参考。方法 回顾性分析2015年1月-2017年12月在北京怀柔医院RICU住院治疗的发生感染的860例患者的病原学检测结果及药敏结果，探讨其病原菌分布及耐药性状况。结果 共分离出3 800株病原菌，主要来源于痰液（63.34%）。其中革兰阳性菌926株，占24.37%，主要以金黄色葡萄球菌、肺炎链球菌和溶血葡萄球菌为主；革兰阴性菌2 482株，占65.31%，主要以大肠埃希菌、鲍曼不动杆菌和铜绿假单胞菌为主；真菌392株，占10.32%，主要以白假丝酵母为主。革兰阴性菌中大肠埃希菌对碳青霉烯类药物（如亚胺培南）、阿米卡星及头孢哌酮等耐药率低，对多黏菌素E高度敏感；鲍曼不动杆菌具有较强的耐药性，仅对多黏菌素E高度敏感；铜绿假单胞菌对多黏菌素E和头孢哌酮耐药率低；革兰阳性菌中金黄色葡萄球菌、肺炎链球菌以及溶血葡萄球菌对万古霉素及替考拉宁的敏感率均较高，而对大环内酯类药物（红霉素、庆大霉素等）的耐药率均较高。结论 北京怀柔医院RICU感染性疾病病原菌以革兰阴性菌为主，且耐药情况较严重。定期监测感染病原菌的分布状况及其耐药性对临床上抗菌药物的合理选择具有重要意义。

Distribution and drug resistance of infectious diseases in intensive care unit of respiratory department in Beijing Huairou Hospital from 2015 to 2017

Objective To explore the distribution of pathogenic bacteria and drug resistance of infectious diseases in intensive care unit of respiratory department in Beijing Huairou Hospital from 2015 to 2017, to provide a reference for the rational choice of antimicrobial drugs in the clinic and controling the infection. Methods The etiological test results and drug susceptibility results of 860 patients hospitalized in RICU from January 2015 to December 2017 in Beijing Huairou Hospital were retrospectively analyzed, and the distribution drug resistance of pathogenic bacteria were investigated. Results A total of 3 800 strains of pathogens were isolated, and most of them were isolated from sputum (63.34%). Gram-positive bacteria bacteria were 926 strains (24.37%), and main of them were Staphylococcus aureus, Streptococcus pneumoniae, and Staphylococcus haemolyticus. Gram-negative (2 482 strains) accounted for 65.31%, and main of them were Escherichia coli, Acinetobacter baumannii, and Pseudomonas aeruginosa. Fungus (392 strains) accounted for 10.32%, and main of them were Candida albicans. E. coli in Gram-negative bacteria had low resistance to carbapenem drugs (such as imipenem), amikacin, and cefoperazone, and it was highly sensitive to polymyxin E. A. baumannii had strong resistance and was only highly sensitive to polymyxin E. P. aeruginosa had low resistance to polymyxin E and cefoperazone. S. aureus, S. pneumoniae, and S. haemolyticus in Gram-positive bacteria had higher sensitivity to vancomycin and teicoplanin, but they had higher resistance to macrolides (erythromycin, gentamicin, etc.). Conclusion Gram-negative bacteria are the main pathogens of RICU infectious diseases in Beijing Huairou Hospital, and the drug resistance is more serious. And regular monitoring of the distribution of infectious pathogens and their drug resistance are important for the rational selection of antimicrobial agents in the clinic.