综合重症监护病房下呼吸道感染病原菌变迁及耐药状况分析

Analysis of pathogens distribution change and drug resistance in low respiratory tract infection in ICU

目的了解下呼吸道感染病原菌的变迁、主要流行病原菌的耐药状况,为临床合理应用抗生素提供依据。方法细菌的分离、鉴定及常用抗生素的敏感、耐药试验。结果病原菌以革兰阴性菌为主,占62.76%,革兰阳性菌次之,占28.12%,真菌占9.12%;位于前5位的病原菌依次为铜绿假单胞菌、大肠埃希菌、金黄色葡萄球菌、鲍氏不动杆菌、表皮葡萄球菌;亚胺培南对主要的革兰阴性(G-)菌具有较好的敏感性,哌拉西林/他唑巴坦对铜绿假单胞菌有较好的敏感性;革兰阳性(G+)菌主要为耐甲氧西林金黄色葡萄球菌(MRSA),成为病原菌的第3位,对万古霉素100.0%敏感。结论目前下呼吸道感染病原菌中多药耐药比例逐年增加,针对产超广谱β-内酰胺酶(ESBLs)菌株建议选用碳青霉烯类,对MRSA推荐用万古霉素。

Objective To investigate the distribution change and drug resistance of common and special pathogens in low respiratory tract infection for providing evidence of clinical anti-infection therapy.Methods Total 537 bacteria strains were isolated.We analyzed the pathogens isolated from the sputa of the hospitalized patients with lower respiratory tract infection.Results The main pathogenic bacteria were Gram-negative bacilli（G-,62.76%）,the second pathogenic bacteria were Gram-positive cocci（G＋,28.12%）.and mycetes（9.13%）occupied the third.The most common pathogens were Staphylococcus aureus,Escherichia coli,Acinetobacter baumannii,and Stenotr op homonas maltop hilia.Imipenem had the better antimicrobial susceptibility to Gram-negative bacilli.Piperacillin/tazobactam had the better antimicrobial susceptibility to Pseudomonas aeruginosa.The main pathogenic Gram-positive organism was meticillin-resistant S.Aureus（MRSA）.All strains of MRSA were antimicrobial sensitive to vancomycin.Conclusion The percentage of multidrug resistant pathogens in low respiratory tract infection has increased with time.Carbopenems are recommended for ESBLs-producing pathogens and vancomycin for MRS.