重症监护病房下呼吸道感染的病原菌分布及耐药性分析

Distribution and Drug Resistance Analysis of Pathogenic Bacteria in Lower Respiratory Tract Infection in Intensive Cure Unit

目的探讨重症监护病房(ICU)患者下呼吸道感染病原菌的分布及耐药性,为临床防治提供科学依据。方法整理分析我院ICU2003年1月至2007年12月下呼吸道感染患者痰培养的1146株病原菌,采用CLSI推荐的K-B法进行药敏试验,并对其耐药性进行分析。结果分离出的1146株病原菌中,革兰阴性杆菌占64.1%,革兰阳性球菌占28.4%。前5位病原菌依次为金黄色葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌、洋葱伯克霍尔德菌、肺炎克雷伯菌。铜绿假单胞菌、鲍曼不动杆菌对亚胺培南耐药率分别为37.8%、10.6%,肺炎克雷伯菌、大肠埃希菌产超广谱β内酰胺酶(ESBLs)的检出率分别是68.5%、83.7%,肠杆菌科菌对亚胺培南全部敏感。未检出耐万古霉素的革兰阳性球菌。结论ICU下呼吸道感染以革兰阴性杆菌为主,病原菌耐药性严重。临床治疗应根据药敏试验结果,合理应用抗生素。

Objective To explore the distribution and drug resistance of pathogenic bacteria in patients with lower respiratory tract infection in intensive cure unit （ICU）, and provide a scientific basis for clinical prevention and treatment. Method 1146 strains of pathogenic bacteria were isolated from patients with lower respiratory tract infection in ICU of our hospital from January 2003 to December 2007. Antibiotic sensitivity test was done according to Kirby Bauer method of CLSI. Result Among 1146 clinical isolates, Gram-negative bacilli accounted for 64.1%, and Gram-positive cocci for 28.4%. The first five pathogenic bacteria were Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, Pseudomonas cepacia, and Klebsiella pneumoniae. 37.8% of Pseudomonas aeruginosa and 10.6% of Acinetobacter baumannii were resistant to imipenem. 68.5% of Klebsiella pneumoniae and 83.7% of Escherichia coli could produce extended spectrum [3-1actamases （ESBLs）. Enterobacteriaceae bacteria were 100.0% sensitive to Imipenem. Vancomycin resistance Gram-positive cocci were not found. Conclusion Gramnegative bacili are main strains of lower respiratory tract infection in ICU, antimicrobial resistance of bacteria are serious. Clinical antimicrobial agents should be used according to the Results of antimicrobial susceptibility test.