目的 分析寧德師范學(xué)院附屬寧德市醫(yī)院重癥醫(yī)學(xué)科（ICU）患者血流感染病原菌的分布及耐藥情況，以指導(dǎo)ICU病原菌的防控及臨床合理用藥。方法 以2018年1月—2022年12月寧德市醫(yī)院ICU患者血培養(yǎng)分離病原菌作為研究對象，分析培養(yǎng)出病原菌的分布特點(diǎn)及對藥物的耐藥情況。結(jié)果 共培養(yǎng)出446株病原菌，其中革蘭陰性菌203株（45.52%），革蘭陽性菌196株（43.95%），真菌45株（10.09%）。檢出率最高病原菌依次是凝固酶陰性葡萄球菌、肺炎克雷伯菌、大腸埃希菌、屎腸球菌和金黃色葡萄球菌。肺炎克雷伯菌對哌拉西林耐藥率最高，為78.46%，對亞胺培南和美羅培南耐藥率為分別為18.46%、20.00%；大腸埃希菌對哌拉西林及環(huán)丙沙星耐藥率最高，為81.36%、50.85%，對碳青霉烯類抗生素全部敏感；鮑曼不動(dòng)桿菌對頭孢哌酮/舒巴坦和美羅培南耐藥率分別為42.86%、50.00%；銅綠假單胞菌對亞胺培南和美羅培南耐藥率分別為21.43%、28.57%；凝固酶陰性葡萄球菌對青霉素類抗生素耐藥率最高，為94.12%，對阿奇霉素、紅霉素及左氧氟沙星耐藥率較高，達(dá)50.00%以上；金黃色葡萄球菌對青霉素耐藥率為100.00%，對萬古霉素全部敏感；屎腸球菌對高濃度慶大霉素耐藥率為28.00%；糞腸球菌對高濃度慶大霉素耐藥率為56.25%。結(jié)論 寧德師范學(xué)院附屬寧德市醫(yī)院ICU患者血流感染感染病菌種類繁多，以凝固酶陰性葡萄球菌和肺炎克雷伯菌為主。病原菌對藥物耐藥率較高，應(yīng)引起臨床重視并合理應(yīng)用抗菌藥物。同時(shí)加強(qiáng)院內(nèi)感染的防控工作，減少或延緩耐藥株的出現(xiàn)。

Objective To analyze the distribution and drug resistance of pathogenic bacteria from patients with bloodstream infection in ICU, so as to guide the prevention of pathogens and rational drug use. Methods The study objects were pathogens isolated from blood cultures of ICU patients from January 2018 to December 2022, the distribution characteristics of pathogens and their resistance to antibiotics were analyzed. Results A total of 446 pathogenic bacteria were isolated, included 203 gram-negative bacteria (45.52%), 196 gram-positive bacteria (43.95%), and 45 fungi (10.09%). The top five pathogens were coagulase negative Staphylococci, Klebsiella pneumonia, Escherichia coli, Enterococcus faecium, and Staphylococcus aureus. Klebsiella pneumonia had the highest resistance rate to piperacillin (78.46%), the resistance rates to imipenem and meropenem were 18.46% and 20.00%, respectively. The resistance rates of Escherichia coli to piperacillin and ciprofloxacin were the highest (81.36% and 50.85%), all of them were sensitive to carbapenem. The resistance rate of Acinetobacter baumannii to cefoperazone/sulbactam and meropenem were 42.86% and 50.00%, respectively. The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 21.43% and 28.57%, respectively. The resistance rate of Coagulase negative Staphylococci to penicillin antibiotics was the highest (94.12%), and the resistance rate to azithromycin, erythromycin and levofloxacin was more than 50.00%. The resistance rate of Staphylococcus aureus to penicillin was 100%, all of them were sensitive to vancomycin. The resistance rate of Enterococcus faecium to high concentration gentamicin was 28.00%. The resistance rate of Enterococcus faecalis to high concentration gentamicin was 56.25%. Conclusion The most common bacteria are coagulase negative Staphylococci and Klebsiella pneumonia in ICU, and most of the bacteria have high drug resistance, so clinical doctors should use antibiotics reasonably. Hospital staff should strengthen the prevention and control of hospital infections, reduce or delay the emergence of drug resistant strains.

R978.1