重症监护治疗病房呼吸道致病菌的菌群分布及耐药性分析

Analysis of the Distribution and Drug Resistance of Pathogenic Bacteria Causing Respiratory Tract Infection in Medical Intensive Care Units

目的了解内科重症监护病房(MICU)呼吸道致病菌的菌群分布及其耐药情况,指导临床合理用药。方法对2002年1月～2004年12月从MICU呼吸道检测出的致病菌及其耐药性资料进行回顾性研究,了解3年间MICU呼吸道致病菌的菌群及其耐药情况。结果内科重症监护病房(MICU)的呼吸道致病菌以革兰阴性杆菌为主占44.7%;革兰阳性球菌占30.5%;真菌占24.8%。前5位的致病菌分别为铜绿假单胞菌(23.2%)、金黄色葡萄球菌(18.7%)、白色念珠菌(18.1%)、凝固酶阴性葡萄球菌(10.6%)、鲍曼不动杆菌(9.2%)。2002～2004年3年间,革兰阴性杆菌对各类抗生素的耐药率较高,耐药率最低是头孢哌酮/舒巴坦(20.7%);革兰阳性球菌对万古霉素、替考拉宁未见耐药株;真菌虽没有明显耐药性,但感染比例较高,其感染在MICU感染中占有重要地位。结论MICU患者呼吸道致病菌的耐药率高,加强菌群分布及其耐药性的监测,对提高抗感染治疗的效果、减少耐药菌株有重要作用。

Objective To investigate the distribution and drug resistance of pathogenic bacteria causing respiratory tract infection in patients of medical intensive care unit （MICU）, and provide information for guided rational drug administration in clinical practice. Methods The MICU pathogenic bacteria distribution and their drug resistances were analyzed retrospectively from January 2002 to December 2004. Results The major （44.7%） pathogenic bacteria causing respiratory tract infection in MICU were Gram-negative bacilli. Gram-positive cocci and true fungus accounted for 30.5% and 24.8%, respectively. The top five pathogenic bacteria were P.aeruginosa （23.2%）, S.aureus （18.7%）, Blastomycesalbicans （ 18.1% ）, S.coagulase-negative （ 10.6% ） and Acinetobacter baumannii （9.2%）. Drug sensitivity tests showed that Gram-negative bacilli were more resistance to various kinds of antibiotics. Only cefoperzone-sulbactm has the lowest drug resistance rate （20.7%）, while the sensitivity of Gram-positive cocci to vancomycin, teicoplanin could be up to 100%. Drug resistance was not foung in true fungus, which played an important role in MICU infections because of its high infection rate. Conclusion Pathogenic bacteria causing respiratory tract infection in patients of MICU were found to have high drug resistance rate. Monitoring the drug resistance and the distribution of pathogenic bacteria in MICU will play an active and important role in enhancing the therapeutic efficiency and reducing the drug resistant bacteria.