重症监护病房慢性阻塞性肺疾病患者病原菌耐药性分析

Analysis on drug resistance of pathogenic bacteria in patients with chronic obstructive pulmonary in ICU

目的了解云浮市人民医院重症监护病房(ICU)住院慢性阻塞性肺疾病(COPD)患者感染因素、致病菌的分布特点和对抗菌药物的耐药性。方法对ICU住院COPD患者各种标本进行细菌鉴定和药敏试验;对其临床资料、试验结果进行回顾性分析。结果从各种送检标本中分离出革兰阴性杆菌最多,占74.01%(225/304),其中以下呼吸道分泌物分离获得革兰阴性菌最多,为91.45%(278/304);革兰阳性菌占7.24%(22/304),其中分离出革兰阴性杆菌前3位的依次为铜绿假单胞菌(23.03)%、鲍曼/溶血不动杆菌(20.39%)、肺炎克雷伯菌(16.78%);革兰阳性菌以溶血葡萄球菌为主,占7.24%。耐药性分析显示:革兰阴性杆菌对临床常用抗菌药物的总体耐药率最低的是亚胺硫霉素(4.7%),其次为氧哌嗪青霉素/他唑巴坦(18.98%),亚胺硫霉素对云浮市人民医院ICU(COPD)分离的鲍曼/溶血不动杆菌、大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌和铜绿假单胞菌的耐药率最低,分别为0.9%、3.4%、3.7%、5.9%、9.8%,大部分细菌呈多重耐药。结论细菌耐药性仍是临床用药最为严重的问题,根据药敏结果及针对病原菌选用抗菌药物是治疗院内感染的重要原则和关键措施。

Objective To investigate the affectoi,as well as distribution characteristic and antibiotic resistance of pathogenic bacteria in patients with chronic obstructive pulmonary （COPD） in intensive care unit （ICU） in the Peoplers Hospital of Yunfu City. Methods Bacterial identification and drug susceptibility test were carried out upon a variety of samples from COPD inpatients. Retrospective analysis was performed on the clinical data and test results. Results The isolating rate of gram-negative bacilli was the highest [74.01% （225/304）] from a variety of submitted samples. The isolating rate of gram-negative bacilli from the the lower respiratory secretions samples accounted for 91.45% （278/304）,and that of gram-positive bacteria was 7. 24% （22/304）. The most frequent three gram-negative bacilli isolates were Pseudomonas aeruginosa （23.03 %）, Baumanii/haemolytius acinetobacter （20.39 %） and Klebsiella pneumoniae （16.78%）. Staphylococcus haemolyticus was the most gram-positive bacterium, accounting for 7.24%. Resistance analysis showed gram-negative bacteria was sensitive to imipenem and piperacillin/Tazo,and the resistance rate was respectively 4.7% and 18. 98%. The resistance rates of Baumanii/haemolytius acinetobacter, Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae and Pseudomonas aeruginosa imipenem to imipenem were 0.9 %, 3.40%, 3.7 %, 5.9 % and 9.8%, respectively. Most bacteria displayed multidrug resistance. Conclusion Bacterial resistance in clinical medication is still the most serious problem; rational application of antibiotics according to drug susceptibility test results is the basic principle and key measure.