Professor Alborzi Clinical Microbiology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Braz J Infect Dis. 2009 Apr;13(2):118-22. doi: 10.1590/s1413-86702009000200009.
We examined epidemiological aspects and bacterial resistance patterns of bacteria isolated from intensive care unit (ICU) patient samples. During a 10 month period (from June 2006 to March 2007), 812 samples of blood, urine and cerebral spinal fluid (CSF) from 553 hospitalized patients, in ICU wards, including pediatric surgical, neonatal, adult surgical I, adult surgical II, general pediatrics, neurosurgical I, neurosurgical II, and internal medical, were collected. Minimum inhibitory concentration (MIC) of antibiotics for bacteria isolates was determined by the E-test method. The internal medicine ICU with 28.7% admissions gave the largest contribution. Coagulase negative staphylococci at frequencies of 66.7 % and 36.5 % and E. coli at 20.9% were the bacteria most frequently isolated from the blood, CSF and urine samples, respectively. Samples taken from patients 20-40 years old were the most frequent (32.2%), while the group of patients over sixty years contributed least (18.5%). Both Gram-positive and - negative isolates expressed resistance to most of the penicillins and cephalosporins tested. Combined therapy with vancomycin and meropenem or imipenem gave the most effective treatment against Gram-positive and Gram-negative isolates based on empirical therapy. High frequencies of multiresistant bacteria in ICUs warn us to administer a few effective antibiotics in our hospitals more wisely in order to reduce selective pressure on sensitive strains. This could help save the life of ICU patients and prevent of spread of resistant isolates in these critical wards. Due to continuous changes in antibacterial susceptibility patterns, periodical antibacterial sensitivity assessment in ICUs should be mandatory.
我们研究了从重症监护病房（ICU）患者样本中分离的细菌的流行病学方面和细菌耐药模式。在 10 个月的时间（从 2006 年 6 月至 2007 年 3 月）内，共从 553 名住院患者（包括儿科外科、新生儿、成人外科 I、成人外科 II、普通儿科、神经外科 I、神经外科 II 和内科）的血液、尿液和脑脊液（CSF）样本中采集了 812 个样本。采用 E 试验法测定抗生素对细菌分离株的最小抑菌浓度（MIC）。入住内科 ICU 的患者占 28.7%，比例最大。凝固酶阴性葡萄球菌的频率分别为 66.7%和 36.5%，大肠埃希菌的频率为 20.9%，是从血液、CSF 和尿液样本中最常分离到的细菌。年龄在 20-40 岁的患者的样本最为常见（32.2%），而年龄在 60 岁以上的患者样本比例最小（18.5%）。革兰氏阳性和阴性分离株对大多数测试的青霉素和头孢菌素均表现出耐药性。根据经验治疗，万古霉素和美罗培南或亚胺培南联合治疗对革兰氏阳性和革兰氏阴性分离株最有效。ICU 中高频率的多耐药菌提醒我们，在医院更明智地使用少数几种有效的抗生素，以减少对敏感菌株的选择压力。这有助于挽救 ICU 患者的生命，并防止耐药分离株在这些关键病房中传播。由于抗菌药物敏感性模式不断变化，ICU 应定期进行抗菌药物敏感性评估。
