重症监护患者下呼吸道感染常见病原菌的耐药性分析

The antibiotic resistance of common pathogens in lower respiratory tract infections patients in intensive care unit

目的:调查我院重症监护患者下呼吸道感染常见病原菌的分布与耐药情况,为抗感染治疗提供依据。方法:对本院重症监护患者下呼吸道感染分离的312株致病菌用VITEK32全自动细菌鉴定及药敏系统进行细菌培养鉴定及药敏试验,部分药敏试验为K-B法。结果:感染革兰阴性杆菌62．8％。主要菌群有铜绿假单胞菌29．5％,鲍曼不动杆菌12．8％,肺炎克雷伯菌10．9％,大肠埃希菌5．8％,嗜麦芽窄食单胞菌5．1％等,革兰阳性球菌18．2％,真菌18．9％,头孢哌酮/舍巴坦和亚胺培南对革兰阴性杆菌搞菌活性较高,铜绿假单胞菌对头孢哌酮/舒巴坦敏感率较高,对亚胺培南的耐药率40．8％,革兰阳性球菌中金黄色葡萄球菌12．8％,耐苯唑西林金黄色葡萄球菌100％。肺炎克雷伯菌、大肠埃希菌ESBLs的检出率分别为39％、59％,真菌以白色念珠菌为主,对常用药物敏感性较高。结论:我院重症监护患者下呼吸道感染主要病原菌常为多重耐药的革兰氏阴性杆菌、MRSA,对常用抗菌药物耐药性较高,真菌所占比例也较高,加强细菌耐药性监测,合理使用抗生素对临床抗感染治疗十分重要。

Objective：To survey the distribution of common pathogens and their antibiotic resistance from patients with lower respiratory tract infections in ICT and provide the reference for treatment of bacterial infection.Methods：Bacterial distribution and drug resistance from ICU patients with lover respiratory tract infections were studied.VITEK 32 system was used to identify the antibiotic resistance of 312 isolated strains automatically,some bacteriostatie tests were operated with Kirby-Bauer method.Resuits：The Gramnegative bacilli were most common pathogens （62.8%）.pathogens included Pseudomonas aeruginosa （29.5%）.Acinetobacter baumannii （12.8%）.Fungi （18.9%）.The resistance rate to Cefope razone/sulbactam and Imipenen was the lowest.Most strains of P.aeruginosa were resistance to all antibiotics tests.but they were still sensitive to Cefope razone/sulbactam.Resistance rate of Imipenen was 40.8%. Staphylococcus aureus was the most prominent in Gram pesitie cocci （12.8%）.MRS accounted for 100% of the isolated S.aureus.The isolated strains of the E.coli and Klebsiella with ESBLs were 59% and 39% respectively.The most of isolated Fungi were Candida albicans .Resistance rate of Fungi was lower.Conclusion：The major causes of bacterial infection of the lower respiratory tract infections in ICT are Gram-negative baciUi,MRSA Resistance rates of bacteria are high.It is urgent to establish a surveillance system on bacterial resistance and select antibiotics for the treatment of patients with infection according to result of susceptibility tests.