重症监护病房下呼吸道获得性细菌感染的临床调查分析

Bacterial Infection of Lower Respiratory Tract in Comprehensive Intensive Care Unit

目的 了解综合性重症监护病房(ICU)下呼吸道感染细菌的流行及变迁的规律,为危重病患者抗感染经 验治疗提供依据。方法对ICU下呼吸道分离的332株细菌用MicroScan WalkAway 40全自动微生物鉴定仪鉴 定。结果其中G-菌196例(59.O％),G+菌105例(31.6％),真菌27例(8.1％);G-菌中以铜绿假单胞菌、鲍氏 不动杆菌、嗜麦芽寡养单胞菌、克雷伯菌、大肠埃希菌为主,共占46.6％;G+菌中金黄色葡萄球菌是首位占 13.3％;耐苯唑西林金黄色葡萄球菌(MRSA)100％、耐苯唑西林表皮葡萄球菌(MRSE)78.6％、耐苯唑西林凝固 酶阴性葡萄球菌(MRS)88.9％;大肠埃希菌与克雷伯菌的ESBLs检出率分别为86.7％、93.8％,真菌以白色念 珠菌为主占59.3％。结论ICU下呼吸道感染的主要致病菌常为多重耐药的G-菌,MRSA、MRSE和MRS,应 积极进行病原菌调查。

OBJECTIVE To survey the distribution and diversity of the bacteria of lower respiratory tract infections in comprehensive intensive care unit (ICU). METHODS Microscan WA-40 system was used to identify the antibiotic resistance of 332 isolated strains automatically. RESULTS Among all isolated strains, the Gram negative bacilli were 196 strains (59. 0%), the Gram positive cocci were 105 strains (31. 6%) and fungi were 27 strains (8. 1%). Pseudomonas aeruginosa , Acinetobacter baumannii, Stenotrophomonas maltophilia , Klebsiella species and Escherichia coli were the main Gram negative bacilli (46. 6%). Staphylococcus aureus was the most prominent in Gram positive cocci (13. 3%). MRSA accounted for 100% of the isolated S. aureus. MRSE for 78. 6% of the S. epidermidis, MRS for 88. 9% of the isolated coagulase negative Staphylococcus. The isolated strains of the E. coli with ESBLs were 86. 7% of all those strains, the Klebsiella with ESBLs were 93. 8%. The most of the isolated fungi were Candida albicans of 59. 3%. CONCLUSIONS The major causes of the bacterial infection of the lower respiratory tract in our ICU are Gram negative bacilli, MRSA, MRSE and MRS, which are multidrug-resitant. It is important to have bacterial survey actively.