烧伤病房下呼吸道感染病原菌谱和耐药性研究

Bacterial Spectrum and Drug Resistance in Patients with Lower Respiratory Tract Infection in Burn Wards

目的 了解烧伤病房下呼吸道感染病原菌谱和耐药性。方法1996年6月-2002年6月间烧伤病房住院 患者合格痰标本细菌学培养,优势菌者以VITEK-32鉴定,药敏机器配套GNS-506、GPS-106,能同时测定肠杆菌 的ESBLs和耐甲氧西林葡萄球菌。结果 1 560例合格痰标本中分离出1 840株细菌和230株真菌,复数菌感染 280例,占17.9％;G-菌占81.5％,G+菌占7.4％,真菌占11.1％;铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、不 动杆菌属、阴沟肠杆菌居分离菌前5位,分别占22.1％、21.8％、16.6％、11.4％、11.3％;药敏结果提示G-菌对 亚胺培南／西司他丁(除天然耐药外),G+菌(除部分肠球菌)对万古霉素均敏感。结论 烧伤病房下呼吸道感染 病原菌以G-菌为主,出现多重耐药,应根据药敏选择抗生素联合用药,降低耐药性的产生。

OBJECTIVE To realize the bacterial spectrum and drug resistance in the lower respiratory tract infections of inpatients in burn wards. METHODS Qualified sputum specimens from inpatients with lower respiratory tract infections between Jun 1996 and Jun 2002 were cultured for bacterial isolation, and the bacteria were identified by VITEK-32; and the antimicrobial activity tests were conducted by VITEK-32 GNS-506, GPS-106, to monitor MRS and ESBLs. RESULTS From 1 560 samples were isolated 1 840 strains of bacteria and 230 strains of fungi, the most (81. 5%) were Gram negative bacilli; few were Gram positives (7. 4%) and fungi (11. 1%). There were 280 cases with multiple bacterial infection (17. 9%). The 5 most commoly isolated bacteria were Pseudomons aeruginosa, Escherichia coli, Klesbsiella pneumoniae, Acinetobacter, and Enterobacter cloacae , with isolating rates being 22. 1 % , 21. 8% , 16. 6% , 11. 4% and 11.3%, respectively. Except that all the Staphylococcus spp were sensitive to vancomycin, Enterobacteriaceae were sensitive to imipenem, all the other i-solated strains showed total resistance to the agents tested in different levels, also the multidrug resistance e-merged in lower respiratory tract infections with multidrug resistance in high levels. CONCLUSIONS In clinical therapy, sensitive antibiotics should selected based on the drug sensitive tests, combined with other agents when necessary to accelerate the clearance of bacteria from infectious respiratory tract in burn wards.