呼吸重症监护室痰标本分离的常见革兰阴性菌药物敏感性分析

Analysis of Antimicrobial Susceptibility of Most Common Gram Negative Bacteria Isolated from Sputum Specimens in Respiratory Intensive Care Unit

目的:分析呼吸重症监护室(RICU)痰标本分离的常见革兰阴性菌药物敏感性,为临床用药提供参考。方法:对2005年1月-2007年1月呼吸重症监护室254例合格痰标本分离出的394株病原体中的常见革兰阴性菌(GNB)的体外药敏活性进行分析。结果:394株病原体以GNB为主(83.0%),最常见的GNB分别为铜绿假单胞菌(40.6%)、肺炎克雷伯杆菌(20.3%)、鲍曼不动杆菌(9.1%)和嗜麦芽窄食单胞菌(7.4%)。阿米卡星、头孢他啶、哌拉西林/他唑巴坦对铜绿假单胞菌保持了较高的的体外抗菌活性,敏感率分别75.0%、67.5%和61.8%,而亚胺培南、美罗培南敏感率较低,仅分别为56.0%和49.0%,环丙沙星耐药最高,其敏感率仅为16.9%;肺炎克雷伯菌仅对亚胺培南、美罗培南具有高敏感率高,其敏感率为98.4%;鲍曼不动杆菌仅对亚胺培南、美罗培南保持较高的敏感率,分别为66.7%、78.1%;嗜麦芽窄食单胞茵对头孢他啶、头孢哌酮/舒巴坦、环丙沙星敏感率较高,分别为69.2%、61.5%和61.5%。结论:RICU痰标本分离的病原菌以GNB为主,对临床常用抗生素耐药情况严重,并出现了相当数量对亚胺培南、美罗培南耐药的GNB。因此,对于RICU呼吸道GNB感染抗菌药物选择更应强调参考体外药敏检测结果,以提高治疗的成功率。

Objective：To analyze the antimicrobial susceptibility of most common gram negative bacteria isolated from sputum specimens in respiratory intensive care units （RICU）. Methods：A total of 394 bacterial strains isolated from 254 valid sputum specimens in RICU from 2005 January to 2007 January were recruited for study and the antimicrobial susceptibility of 394 bacterial strains was determined in vitro. Results： With an overall isolation rate of 83.0% ,an extremely high prevalence of gram negative bacteria was identified, including pseudomonas aeruginosa （40.6 % ）, klebsiella pneumoniae （20.3 %）, acinetobacter baumannii （9. 1 %）and stenotrophomonas maltophilia（7.4 %）. Amikacin, ceftazidime, piperacillin/tazobactam had a high degree of antimicrobial activity against pseudomonas aeruginosa, while imipenem and meropenem were relatively low, the susceptibility rates were 75.0%, 67.5% , 61.8%, 56.0% and 49.0% respectively, the susceptibility rate of Pseudomonas aeruginosa to ciprofloxacin was only 16. 9% ; The remarkably high susceptibility rate against klebsiella pneumoniae was only present in imipenem （98.4%） and meropenem （98. 4%）; The susceptibility rates of acinetobacter baumannii to imipenem, meropenem were 66.7% and 78.1% respectively; ceftazidime, cefoperazone/sulbactam, ciprofloxacin showed good antimicrobial activity against stenotrophomonas maltophilia, the susceptibility rates were 69. 2%, 61.5% and 61.5% respectively. Conclusion： The gram negative bacterial were the main pathogens in RICU and the high resistant rates to routine antibiotics have been confirmed. The imipenem-resistant and meropenem-resistant strains were also found. The surveillance of antimicrobial susceptibility and reasonable application of antibiotics should be emphasized, especially for RICU patients.