The Surveillance Of The Antibiotic Resistance In ICU In Shandong Province During 2010-2014

Objective:The objectives of this study were to investigate the bacterial resistance profile of clinical isolates from 34 hospitals in Shandong Province from the Intensive Care Unit during2010- 2014,to establish the prevalence of bacterial infection and distribution of resistant nosocomial pathogens and to guide our clinical practice.Methods:The antimicrobial susceptibility was tested according to an agreed ptotocol using Kirby-Bauer method. Data were analyzed according to CLSI 2011. WHONET5.6 was applied for analyzing the bacterial sensitive data.Results:A total of 50219 clinical isolates of pathogens, from 49946 samples,include sputum samples(78.28%,n=38958),blood cultures(9.87%, n=4929), urine samples(7.63%,n=3810), pyogenic fluids(2.40%,n=1198),venous catheter(1.19%,n=594), and cerebrospinal fluid(1.16%,n=579),And include Gram-negative bacteria(80.50%,n=40427),Gram-positive bacteria(12.79%,n=6424),and fungi(6.71%,n=3368).A total of 40427 Gram-negative bacteria include Acinetobacter baumannii(32.1%,n=12977),Pseudomonas aeruginosa(28.2%,n=11400),Klebsiella pneumoniae(14.6%,n=5902),Escherichia coli(10.7%,n=4326),Stenotrophomonas maltophilia(5.6%,n=2263),Proteus mirabilis(3.3%,n=1334),Enterobacter species(1.9%,n=768), Brukholderia cepacia(1.0%,n=405),and others(2.4%,n=970).A total of 6424 Gram-positive bacteria include Staphylococcus aureus(53.7%,n=3449),Enterococcus species(23.2%,n=1490),Staphylococcus epidermidis(9.8%,n=629),Staphylococcus haemolyticus(8.0%,n=514),and others(5.5%,n=353).A total of 1490 Enterococcus species bacteria include Enterococcus Faecium(67.9%,n=1012) and Enterococcus faecalis(32.1%,n=478).A total of 3368 fungi include Aspergillus species(6.0%,n=202),Candida species(94.0%,n=3166).A total of 3166 Candida species include Candida albicans(44.7%,n=1614),Candida species,not albicans(55.3%,n=1752).A total of 1752 Candida species,not albicans,Candida tropicalis(41.7%,730),Candida glabrata(32.0%,n=561),Candida parapsilosis(9.4%,n=165) and Candida krusei(5.5%,n=96).The resistance rate of Enterobacter cloacae,Proteus mirabilis and Escherichia coli to cephalasporins is on the rise,whereas that of Klebsiella pneumoniae appears a decreasing trend. As for Non-fermentative gram,the resistance rate to Minocycline and Cefoperazine-sulbactam was relatively low while to other antibacterials was more than 30%.Acinetobacter baumannii to Meropenem and Imipenem resistance rates were 78.7% and 80.0% in 2010, raising to 90.8% and 91.2% in 2014,remaining a high level of resistance rate and on the rise overall.Pseudomonas aeruginosa to Meropenem and Imipenem resistance rates were 50.9% and 50.8% in 2010,down to 90.8% and 91.2% in 2014.The resistance rate to Amikacin was less than 30%,to other antibacterials was more than 30%, and to Amikacin, Cefoperazine-sulbactam and Levofloxacin was relatively acceptable.Pseudomonas aeruginosa is obviously more sensitive to antibacterials compared with Acinetobacter baumannii.Stenotrophomonas maltophilia to Minocycline, Levofloxacin and Cefoperazine-sulbactam were less than 30%.Burkholderia cepacia to Piperacillin-tazobactam, Cefoperazine-sulbactam,Ceftazidime, Meropenem and Levofloxacin resistance rates were less than 30%. The methicillin-resistant detection rates of Staphylococcus aureus and coagulase negative staphylococci were 63.7% and 82.8%.No Staphylococcus strain was resistant to vancomycin, teicoplanin and linezolid.The drug resistance rates of Enterococcus faecium and Enterococcus faecalis to vancomycin were 6.4% and 1.3%,to teicoplanin 5.0% and 2.1%,to linezolid 1.2% and 1.3%. As for fungi,mostly Candida species,the detention rate of Candida albicans and Candida species,not albicans appears generally equal.Amphotericin B remains a high level of sensitivity to fungi.The resistance rate of Candida albicans to various kinds of Antifungal medication was less than 10.0% and on a downward trend,that of Candida tropicalis and Candida glabrata was less than 25.0%.The resistance rate of Candida glabrata to triazole Antifungal medication appears on the rise.methicillin-resistant Staphylococcus bacteria,ESBLs-producing enterobacteria and multidrug-resistant non-fermented bacteria are commonly found.Conclusions: The disseminated multi-drug or pan-drug resistant strans in ICU poses a severe threat to clinical practice,which implies the importance of establishing the prevalence of bacterial resistance and indicates the significance of strengthening infection control and optimizing antimicrobial therapy in critically ill patients.The bacterial resistance rates in ICU is notably higher than those of overall departments during the contemporary surveillance.