经验性应用β-内酰胺类抗菌药物对医院获得性肺炎病原菌的影响

Effect of Empirically Applying β-Lactam Antibiotics for Treatment of Hospital-acquired Pneumonia on Pathogenic Bacteria

目的探讨医院获得性肺炎经验性治疗阶段应用β-内酰胺类抗菌药物对病原菌构成和耐药性的影响。方法调查ICU 2001年1月-2005年10月,医院获得性肺炎患者141例,依据初始抗菌策略不同,将所选患者分为3组:三代头孢组、β-内酰胺酶抑制剂组、其他β-内酰胺类抗菌药物组,分析3组患者病原菌构成及耐药性的差异。结果共分离出病原菌株164株。β-内酰胺酶抑制剂组中G+球菌所占比例明显增加,与其他两组相比,差异有统计学意义;将三代头孢组与其他β-内酰胺类抗菌药物组相比较,三代头孢组中G-杆菌对β-内酰胺类抗菌药物的敏感性下降,但差异性无统计学意义;β-内酰胺酶抑制剂组中G-杆菌对β-内酰胺类抗菌药物的敏感性明显高于三代头孢组,差异有统计学意义。结论在初始治疗阶段选择抗菌策略时,既要考虑抗菌策略的有效性,也要考虑其对病原菌构成和耐药性的影响。及时进行细菌培养及药敏试验的复查,及时发现病原菌构成和耐药性的变化。

OBJECTIVE To approach the effect of empirically applying β-lactam antibiotics for treatment of hospital- acquired pneumonia on distribution and antibiotic-resistance of pathogenic bacteria. METHODS To investigate 141 patients with hospital-acqired pneumonia in intensive care unit during Jan 2001-Oct 2005, and divide into 3 groups; third generation cephalosporin group; lactamase inhibitor group; and other lactam antibiotics group according to different initial antibacterial strategy, then analyze difference in distribution and antibiotic-resistance of pathogens among each group. RESULTS We acquired 164 strains of pathogens. Comparing with other two groups, the proportion of Gram-positive cocci in lactamase inhibitor group was higher significantly（P〈0.05）. Drug-sensibility to β-lactam antibiotics in third generation cephalosporin group was lower than in other lactam antibiotics group, but this difference was not significant. Comparing with third generation cephalosporin group, in lactamase inhibitor group drug-sensibility of Gram-negative bacilli to β-lactam antibiotics increased significantly. CONCLUSIONS Either the efficacy or the effects on distribution and antibiotic-resistance of pathogens must be considered during selecting empiric antibacterial therapy. Meanwhile bacterial culture and susceptibility test must be rechecked in time.