Common Pathogenic Bacteria And The Resistance Of Antimicrobial In Comprehensive ICU

Background Patients treated in the ICU were in a critical condition, andassociated with respiratory or other organ damage made them need some invasivetreatment, like undergo endotracheal intubation/tracheotomy, mechanical ventilation,central venous catheters, urethral catheters. These operations are easy to make abacterial colonization and cause an infection. Since the majority of patients with ahistory of long~-term use of antibiotics during the treatment, bacterial infections of theICU patients are mainly caused by drug resistance bacteria. It’s difficult to control theinfection and to save the patient as the multi~-resistant strains emerge. Studies of othercountries suggested that the rate of ICU patients with drug~-resistant bacteria infactionwere increasing. Select the correct antibiotics to control the infection in a timely manner,is an important factor of increase the success rate of rescue. And correct selection ofantibiotics can also reduce the generation of resistant bacteria. Therefore, it is necessaryto analyyze the bacteria and drug resistance in the ICU. Now we analyzed the bacteria,which were isolated from the comprehensive ICU of our hospital in January2008~December2011, and their drug resistance for helping to select the antibiotics.Objective Investigate the distributions and the drug resistances of pathogenicbacteria in comprehensive ICU of our hospital for the guidance of clinical medication.Method We retrospectively analyzed the distributions and the antibioticsusceptibilities of bacteria, isolated from January2008to December2011.Results1.strain distribution:2306strains were isolated from the comprehensiveICU of our hospital from January2008to December2011. Gram~-negative (G~-) bacteria1551, accounting for67.3%; Gram~-negative (G~+) bacteria755, accounting for32.7%.The main G~-bacteria followed by Acinetobacter baumannii (29.9%), Pseudomonasaeruginosa (22.3%), Klebsiella pneumoniae (22.2%), Escherichia coli (12.2%),Enterobacter aerogenes (2.5%), Enterobacter cloacae (2.2%). Common G~+bacteria wereCoagulase~-negative staphylococci(39.3%), Enterococcus faecium(28.1%), Staphylococcus aureus(23.6%), Enterococcus faecalis(4.8%).2.Drug~-resistant of G~-bacteria: In these four years Acinetobacter baumannii were themost common G~+bacteria, the total strains were464, and the rate of their drug resistantto all kinds of antibiotics were no less than63.1%. Acinetobacter baumannii hadbecome the largest number of G~-bacteria in2009, and sustained that over the next2years. The rate of drug resistance of Acinetobacter baumannii to all kinds of antibioticsshowed an upward trend.3. Drug~-resistant of G~+bacteria: Coagulase~-negative staphylococci, Staphylococcusaureus and Enterococcus faecalis to linezolid and vancomycin resistance rate were,0.Enterococcus faecium to linezolid and vancomycin resistance rates were1.4%and1.0%respectively.Conclution In these four years, the infection proportion of G~-bacteria increasedyear by year, the majority is Acinetobacter baumannii. Common G~-bacteria wereAcinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae,Escherichia coli, among them, Acinetobacter baumannii increased most obviously. Athome and abroad in recent years, the study also suggest that the measures to preventionof Acinetobacter baumannii infection should be actively implemented. To treat commonG~-bacteria infection, the choice of antibiotics are imipenem, piperacillin/tazobactam,amikacin, alternate ticarcillin/clavulanic acid. Cefoperazone/sulbactam susceptibilitytest hadn’t been done, but other domestic report suggest the resistance rate was low.Common G~+bacteria were Coagulase~-negative staphylococci, Enterococcus faecium,Staphylococcus aureus, Enterococcus faecalis. The percentage of MRCNS and MRSAin the comprehensive ICU of our hospital were89.2%and88.8%respectively. Theabove four main strains got some low resistance rates to linezolid and vancomycin. Andthe rates of coagulase~-negative staphylococci, Staphylococcus aureus and Enterococcusfaecalis were zero. We found a small number of Enterococcus faecium strains resistantto vancomycin or linezolid. Therefore, linezolid and vancomycin are the better choicefor the treatment of common G~+bacteria infections.