目的 了解某院重症监护病房(ICU)革兰阴性菌(G-)分布及耐药情况,为合理使用抗菌药物提供依据。方法 收集医院ICU 2013-01至2013-12行病原菌检测为革兰阴性菌的病历资料,对患者基本情况、病原菌种类、药敏结果及细菌耐药性等情况进行统计分析。结果 在送检标本中,共检出致病菌461株,其中革兰阴性菌328株,占总数的71.1%。在革兰阴性菌中,主要为鲍曼不动杆菌和铜绿假单胞菌,其比例分别为48.2%和23.5%。这两种菌分别有82.9%和94.8%分离自痰标本。药敏结果显示亚胺培南对除鲍曼不动杆菌和嗜麦芽窄食单胞菌外的其他革兰阴性菌均较敏感。鲍曼不动杆菌对于除多黏菌素E、阿米卡星外的其他抗生素均呈现高度的耐药性。而嗜麦芽窄食单胞菌对喹诺酮类抗菌药物如左氧氟沙星、环丙沙星较为敏感。结论 某院ICU病房革兰阴性菌分离率很高,并且存在很严重的耐药情况,及时监测耐药菌株变化及耐药增长趋势有重要意义。

Objective To investigate the distribution and resistance of Gram-negative bacteria in intensive care unit, so as to help physicians to choose reasonable antibiotics. Methods Case histories were collected in which laboratory findings of Gram-negative bacteria in the intensive care unit in hospital during 2013 were recorded. A statistical analysis was made of the basic conditions of patients ,the sorts of pathogenic bacteria, the results of AST and bacterial drug resistance. Results In all the samples examined, there were 461 strains in all, in which there were 328 strains of gram-negative bacteria ,consisting of 71.1%.In all the gram-negative bacteria separated, there were mainly Acinetobacter baumannii and Pseudomonas aeruginosa, the ratio being 48.2% and 23.5%. 82.9% of Acinetobacter baumannii and 94.8% of Pseudomonas aeruginosa were separated from sputum, respectively. Imipenem shows great multiantibiotic resistance to Acinetobacter baumannii and stenotrophomonas maltophilia, and it is sensitive to the other gram-negative bacteria. Stenotrophomonas maltophilia is sensitive to quinolone antimicrobial agents, such as levofloxacin and ciprofloxacin. While Acinetobacter baumannii shows highly multiantibiotic resistance to antibiotics except amikacin and polymyxin E. Conclusions In the 2013, the separation rate of gram-negative bacteria in the ICU in this hospital was very high. And the infection of gram-negative in the intensive care unit was severe. It is important to carry out surveillance of bacteria resistance and the growth of bacteria resistance in time, which can guide the doctor to use drugs reasonably.