Objective To investigate the type, distribution and antimicrobial resistance of pathogens associated with nosocomial infection in the patients in Medical Intensive Care Unit (MICU) in order to provide the information for reasonable use of antimicrobial agents in clinic and guide the antimicrobial resistance monitoring. Methods The isolated pathogens and its antimicrobial resistance status from samples which were collected from patients hospitalized in the MI-CU from Jan. 2013 to Jun. 2016 were retrospectively analyzed. Antimicrobial susceptibility test were performed by Kir-by-Bauer disc diffusion method, and the results of antimicrobial susceptibility test were judged by the standards of Clini-cal and Laboratory Standards Institute. WHONET software was used for the statistical analysis. Results A total of 607 strains of pathogenic bacteria were isolated, including 439 strains (72.3％) of Gram-negative bacilli, 130 strains (21.4％) of Gram-positive cocci and 38 strains (6.3％) of fungi. Acinetobacter baumannii, Pseudomonas aeruginoss, Escherichia coli, Klebsiella pneumonia, Stenotrophomonas maltophilia ranked the top 5 species of the Gram-negative bacilli, in which non-fermenters Gram-negative bacilli accounted for 70.8％(311/439). Staphylococcus aureus, Epidermis staphylococcus and Staphylococcus haemolyticus were the main Gram-positive cocci. A total of 284 strains of Gram-negative bacilli were mul-tidrug-resistant, including 51 strains (18.0％) of extended-spectrum β-lactamases-producing Escherichia coli (ESBLE-COL) and extended-spectrumβ-lactamases-producing Klebsiella pneumonia (ESBLKPN), 103 strains (36.3％) of multi-drug-resistant Acinetobacter baumannii (MDR-AB), and 75 strains (26.4％) of multidrug-resistant Pseudomonas aerugi-noss (MDR-PA). A total of 57 strains of Gram-positive bacteria were multidrug-resistant, which were mainly methicil-lin-resistant Staphylococcus aureu and methicillin-resistant coagulase negative Staphylococcus, with antimicrobial sensi-tive rates of 100％ to vancomycin and linnezolid. Candida albicans was the main fungi detected, with an antimicrobial sensitive rate of over 80％to antifungal agents. Conclusion Most of the pathogenic bacteria causing nosocomial infec-tion isolated from MICU are Gram-negative bacteria, with non-fermentation bacteria and multidrug-resistant bacteria be-ing dominant. Surveillance of antibiotic resistance of pathogenic bacteria should be strengthened in ICU, and the rational use of antimicrobial agents should be guided by the results of antimicrobial susceptibility test.%目的 探讨内科重症监护病房患者医院感染病原菌类型、分布及耐药情况,为指导医院感染病原菌耐药性监测和临床合理应用抗菌药物提供依据.方法 回顾性分析2013年1月至2016年6月海南医学院第二附属医院内科ICU住院患者送检标本中分离的病原菌及其对临床常用抗菌药物的耐药性.药敏试验采用K-B纸片扩散法,药敏结果依据美国临床实验室标准化研究所标准进行判定,采用WHONET软件进行统计分析.结果 共分离出病原菌607株,其中革兰氏阴性杆菌占72.3％(439株),革兰氏阳性球菌占21.4％(130株),真菌占6.3％(38株).革兰氏阴性杆菌主要为鲍曼不动杆菌、铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、嗜麦芽窄食单胞菌,其中非发酵革兰氏阴性杆菌占70.8％(311株),革兰氏阳性菌主要为金黄色葡萄球菌、表皮葡萄球菌、溶血葡萄球菌.多重耐药革兰氏阴性杆菌284株,其中产超广谱β-内酰胺酶的大肠埃希菌(ESBLECOL)和肺炎克雷伯菌(ESBLKPN)占18.0％(51株),多重耐药鲍曼不动杆菌(MDR-AB)占36.3％(103株),多重耐药铜绿假单胞菌占(MDR-PA)26.4％(75株).多重耐药革兰氏阳性球菌57株,主要为耐甲氧西林金黄色葡萄球菌、耐甲氧西林凝固酶阴性葡萄球菌,对万古霉素、利奈唑胺敏感率为100％.真菌主要为白色假丝酵母菌,对抗真菌药物敏感性≥80％.结论 内科ICU患者医院感染的致病菌主要为革兰氏阴性杆菌,且主要为非发酵革兰氏阴性杆菌和多重耐药菌.ICU应加强病原菌耐药性监测,并根据药敏结果指导合理应用抗生素.
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