呼吸重症监护室痰细菌培养及革兰阴性菌耐药性分析

Analysis of Sputum Bacteria Culture and Antimicrobial Resistance of Gram Negative Bacteria in Respiratory Intensive Care Unit

目的分析呼吸重症监护室(RICU)痰标本分离的常见革兰阴性菌(GNB)的药物敏感性。方法对2005年1月至2007年1月RICU的64例患者254份合格痰标本分离出的394株病原体中常见GNB的体外药物敏感性进行分析。结果394株病原体以GNB为主(82.99%),最常见的GNB分别为铜绿假单胞菌(40.61%)、肺炎克雷伯菌(20.30%)、鲍曼不动杆菌(9.14%)和嗜麦芽窄食单胞菌(7.36%)。铜绿假单胞菌对阿米卡星、头孢他啶、哌拉西林他唑巴坦的敏感率分别为75.0%,67.5%,61.8%,而对亚胺培南、美罗培南的敏感率仅为56.0%和49.0%,对环丙沙星的敏感率仅为16.9%;肺炎克雷伯菌仅对亚胺培南、美罗培南敏感率高(均为98.4%);鲍曼不动杆菌仅对亚胺培南、美罗培南保持较高的敏感率,分别为66.7%和78.1%;嗜麦芽窄食单胞菌对头孢他啶、头孢哌酮舒巴坦、环丙沙星的敏感率较高,分别为69.2%,61.5%,61.5%。结论对于RICU呼吸道GNB感染,抗菌药物的选择更应强调参考体外药物敏感试验结果,以提高治疗的成功率。

Objective To analyze the antimicrobial resistance of most common Gram negative bacteria（GNB） isolated from sputum specimens in the respiratory intensive care units（RICU）. Methods A total of 394 bacterial strains isolated from 254 valid sputum specimens in RICU from January 2005 to January 2007 were recruited for study and the antimicrobial susceptibility of 394 bacterial strains was determined in vitro. Results Among 394 isolates, the main pathogens were GNB （82.99%）, including psendomonas aeruginosa （40. 61% ）, klebsssiella pneumoniae （20. 30% ）, acinetobacter baumannii （9. 14% ） and stenotrophomonas maltophilia （7.36%）. Amikacin. ceftazidime, piperacillin/ tazobactam had the high degree of antimicrobial activity against pseudomonas aeruginosa, while imipenem and meropenem were relatively low, the susceptibility rates were 75. 0%, 67. 5%, 61.8%, 56. 0% and 49. 0% respectively. The susceptibility rate of Pseudomonas aeruginosa to ciprofloxacin was only 16.9%. The remarkably high susceptibility rates of acinetobacter baumannii to imipenem, meropenem were 66.7% and 78. 1% respectively, Ceftazidime, cefoperazone/sulbactam, eiprofloxacin showed good antimicrobial activity against stenotrophomonas maltophilia, the susceptibility rates were 69.2%, 61.5% and 61.5% respectively. Conclusion The gram negative bacteria are the main pathogens in RICU and the high resistant rates to routine antibiotics have been confirmed. The imipenem- resistant and meropenem- resistant strains are also found. The surveillance of antimicrobial susceptibility and reasonable application of antibiotics should be emphasized, especially for the RICU patients.