ICU与非ICU呼吸道感染革兰阴性杆菌及其耐药率的比较

Drug Resistant Rate and Spectrum of Common Gram-negative Bacilli Isolated from Respiratory Tract of Patients:A Comparison Between ICU Ward and Non-ICU Ward

目的了解重症监护病房(ICU)与非ICU呼吸道感染革兰阴性杆菌的流行病学,分析比较两个病区的细菌耐药情况,为不同病区呼吸道感染的经验治疗提供依据。方法用VITEK-2和API系统对细菌进行鉴定,采用K-B纸片扩散法进行药敏试验,用WHONET 5.3软件进行数据分析。结果呼吸道标本中共分离革兰阴性杆菌2184株,其中ICU分离655株、非ICU分离1529株;在ICU中排在前5位的病原菌分别为铜绿假单胞菌、洋葱伯克霍尔德菌、鲍氏不动杆菌、脑膜脓毒金黄杆菌和嗜麦芽寡养单胞菌,可见非发酵菌是ICU呼吸道感染的主要病原菌;在非ICU中排在前5位的病原菌依次为铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌、洋葱伯克霍尔德菌和嗜麦芽寡养单胞菌;ICU分离的病原菌普遍比非ICU耐药,而左氧氟沙星在ICU比非ICU显示出较好的抗菌活性。结论呼吸道感染是医院感染的危险因素之一,ICU呼吸道标本分离的革兰阴性杆菌的耐药率普遍高于非ICU,且以多药耐药的非发酵菌为主,应引起临床医生的重视。

OBJECTIVE To learn the epidemiology of respiratory infection in ICU and non-ICU wards, and analyze the difference of drug resistance of Gram-negative bacilli between those two wards in order to provide the basis of empirical therapy for the respiratory infection from the different wards. METHODS The bacteria were identified by VITEK-2 and API system. Antibiotic sensitivity test adopted by K-B method. Data were analyzed by WHONET 5.3 software. RESULTS Totally 2184 strains of Gram-negative bacilli were isolated all from the respiratory tract, among which 655 strains were isolated from ICU ward and 1529 strains were from non-ICU ward. In ICU ward, the first five bacteria were Pseudornonas aeruginosa, Burkholderia cepacia, Acinetobacter baurnannii, Chryseobacteriurn rneningosepticurn, and Stenotrophornonas rnaltophilia. It showed that non-fermentatives were the main pathogenic bacteria in ICU. In non-ICU ward, the first five bacteria were P. aeruginosa, Klebsiella pneurnoniae, A. baurnannii, B. cepacia, and S. rnaltophilia. Drug resistant rate of strain from ICU ward was generally higher than that from non-ICU ward, while levofloxacin in ICU ward showed the better activity than in non-ICU ward. CONCLUSIONS The respiratory infection is one of the hazards in nosocomial infection, drug resistant rate of Gram-negative bacilli from respiratory specimen in ICU is generally higher than that in non-ICU, and the main strains are the mlti-resistant non-fermentatives, which should attract the clinician＇s more attention.