呼吸病房院内下呼吸道感染细菌及其耐药性的变迁

Distribution and Drug Resistance of Bacteria in Patients with Nosocomial Lower Respiratory Tract Infection in Respiratory Ward

为了解呼吸病房院内下呼吸道感染 (LRTI)病原菌和耐药性的变迁 ,为合理用药提供依据 ,回顾调查1 998— 2 0 0 2年天坛医院呼吸病房院内LRTI患者的痰培养结果 ,药敏用MIC法测定。结果 :共检测出病原菌 43 0株。革兰阴性 (G- )杆菌 (GNB) 73 % ,比例逐年下降 ;其中非发酵菌群 64% ,比例上升。革兰阳性 (G+ )球菌 (GPB) 2 7% ,比例逐年上升 ;其中金黄色葡萄球菌 (SA) 3 2 % ,比例上升 ,耐甲氧西林SA(MRSA) 2 6% ,比例上升。细菌耐药率逐渐上升 ,仅GNB对亚胺培南、GPB对万古霉素的耐药率上升较慢 ,分别为 1 7%、0。提示 :院内条件致病菌的比例上升 ,耐药率上升 ,亚胺培南、万古霉素等少数药物成为院内感染治疗的主力药物。要改善现状 。

The aim was to study the changes on the distribution and drug resistance of the bacteria in patients with the nosocomial lower respiratory tract infection (LRTI) in respiratory ward. The sputum's culture of the patients with the nosocomial LRTI in respiratory ward from 1998 to 2002 was studied with MIC methods. Results: 430 strains were isolated, 73% of which were Gram negative bacillus (GNB) and decreased gradually; 64% of GNB were non fermenters and increased. 27% of which were Gram positive bacteria (GPB) and increased; 32% of GPB were S. aureus (SA) and increased, 26% of GPB were methicilin resistant SA (MRSA) and increased. Drug-resistant was growing, only few drugs, such as vancomycin to GPB (0) and Imipenem to GNB (17%), kept lower resistance. Conclusions: The distribution and drug resistance of the bacteria had been changing with time and antibiotics use, nosocomial pathogens have shifted away from easily treated bacteria toward more resistant bacteria. Few drugs, such as vancomycin and imipenem and so on, can be selected to treat nosocomial pathogens. Integrated management is a method to improve it.