重症监护病房下呼吸道感染病原菌分布及耐药性分析

Surveillance of Pathogens Distribution and Antibiotic Resistance in Lower Respiratory Tract Infection in ICU

目的了解重症监护病房(ICU)患者下呼吸道感染的病原菌分布及耐药现状,为临床合理使用抗菌药物提供依据。方法取ICU下呼吸道感染患者深部痰做病原菌培养,用VITEK-AMS60全自动微生物仪进行菌种鉴定及K-B法药敏试验。结果从2007年1月-2008年3月送检的320份痰标本中,分离出367株病原菌,其中革兰阴性杆菌261株,占71.1%,真菌70株,占19.1%,革兰阳性球菌36株,占9.8%;鲍氏不动杆菌分离率为21.8%,该菌对头孢哌酮/舒巴坦耐药率为16.7%,其他13种抗菌药物耐药率均>71.0%;大肠埃希菌、肺炎克雷伯菌超广谱β-内酰胺酶(ESBLS)发生率分别为65.2%、72.0%,耐甲氧西林金黄色葡萄球菌(MRSA)发生率为84.6%。结论ICU患者下呼吸道感染病原菌以革兰阴性杆菌为主,鲍氏不动杆菌排列居首,耐药情况显著,真菌感染严重,应引起临床重视。

OBJECTIVE To investigate the distribution of pathogens and their antibiotic resistance in lower respiratory tract infection （LRTI） from intensive care unit （ICU） in our hospital, and provide basis for rational selection of clinical drugs. METHODS Pathogens were detected from qualified sputum specimens in LRTI from ICU and identified by VITEK-AMS60 automatic microbial analyzing system. Drug susceptibility was determined by K-B test. RESULTS From 320 sputum specimens 367 pathogens were detected between from Jan 2007 to Mar 2008, including 261 strains （71. 1%） of Gram-negative bacilli, 70 strains （19. 1%） of fungi, and 36 strains （9.8%） of Gram-positive cocci. 21.8% Of the isolated pathogens were Acinetobacter baumannii, with 16.7% of drug-resistant rate to cefoperazone/sulbactam and over 71% to other 13 antibiotic agents. The rate of extended spectrum β-lactamases （ESBLs） producing Escherichia coli isolates and Klebsiella pneumoniae ones were 65.2% and 72.0%, respectively, comparing to 84. 6% for meticillin-resistant Staphylococcus aureus （MRSA）. CONCLUSIONS Gram-negative bacilli are the major pathogens of LRTI in ICU, in which A. baurnannii shows with a high rate of drug-resistance, followed by fungi, which should attract the clinician＇s more attention.