我院ICU下呼吸道感染革兰阳性菌分离情况及耐药性分析

Gram-positive bacterial isolates and resistance analysis in lower respiratory tract infection in ICU

目的:探讨我院ICU下呼吸道感染中常见的革兰阳性细菌分离情况及耐药性,以指导临床用药。方法:采用回顾性分析方法,收集我院ICU下呼吸道感染临床送检的痰培养的资料,包括细菌鉴定及药敏试验。细菌鉴定采用法国梅里埃公司VITEK-32全自动微生物分析系统鉴定;药敏试验方法,采用K-B(Kirby-Bauer)法,严格按照CLSI标准判定敏感菌株。结果:共分离到病原菌504株,革兰阳性菌145株,占分离菌的28.8%,以金黄色葡萄球菌为主,占革兰阳性菌的63.4%;革兰阴性菌286株,占分离菌的56.7%;真菌73株,占分离菌的14.5%。药敏结果提示,革兰阳性菌对青霉素的耐药率达100%,对万古霉素、替考拉宁的敏感率达100%。结论:革兰阳性细菌是ICU下呼吸道感染的主要病原微生物之一,其耐药现象严重;万古霉素、替考拉宁是治疗耐药的革兰阳性菌感染的有效药物。

Objective：To study the drug sensitivity or resistance and distribution of Gram-positive bacteria in lower respiratory tract infection among inpatients in ICU and to summarize the experience for reference of clinical application.Methods：The clinical data of lower respiratory tract infection in ICU of our hospital from July 20,2007 to August 20,2008 were retrospectively analyzed.The bioMerieux＇s VITEK-32 automatic analysis system was used for identification of bacteria;the susceptibility testing was performed with KB（KirbyBauer） method,in strict accordance with CLSI standards for determining sensitive strains.Results：A total of 504 pathogens were isolated,including 145 strains of Gram-positive bacteria,accounting for 28.8% of isolates,Staphylococcus aureus,accounting for 63.4% of Grampositive bacteria;286 strains of Gram-negative bacteria,accounting for 56.7% of isolates;73 strains of fungi,accounting for 14.5% of isolates.The susceptibility results indicated that the resistant rate of Gram-positive bacteria to penicillin was 100%,the sensitivity rate to vancomycin and teicoplanin reached 100%.Conclusion：The antibiotic resistance of Gram-positive bacilli in ICU patients with lower respiratory tract infection is severe.Vancomycin and teicoplanin are effective for the treatment of resistant Gram-positive bacterial infections.