医院ICU呼吸道感染病原菌的临床分布及其耐药现状

Analysis of pathogenic bacterium classification in respiratory infection and drug resistance in intensive care unit

目的了解和掌握ICU呼吸道感染病原菌的临床分布及其耐药情况,为医院临床感染尤其是ICU感染的控制提供依据。方法将1917份痰标本进行培养,分离出900株病原菌,采用法国生物梅里埃公司全自动细菌鉴定仪进行鉴定和药敏试验。结果 900株病原菌中,G-杆菌718株(占79.8%),G+球菌47株(占5.2%),真菌135株(占15.0%)。革兰阴性杆菌中以铜绿假单胞菌和洋葱伯克霍尔德菌多见,各占22.6%、17.8%。革兰阳性球菌以金黄色葡萄球菌为主,占3.6%。真菌以白假丝酵母菌为主,占14.0%。药敏显示,主要病原菌对临床常用抗菌药物的耐药率均较高且具有多重耐药性,除嗜麦芽窄食单胞菌和洋葱伯克霍尔德菌外,其他革兰阴性杆菌对碳青霉素烯类最敏感,耐药率<10%;革兰阳性球菌对万古霉素、替考拉宁和利奈唑烷耐药率最低;常用抗真菌药物对各种念珠菌均有很高的抗菌活性。结论 ICU获得性呼吸道感染的病原菌多为多重耐药菌,临床应依据病原菌的病原学及耐药性资料,合理选择和使用抗菌药物,有效控制感染,减少新的耐药菌株出现。

Objective To investigate and master the classification of pathogenic bacterium in respiratory infection and drug resistance in intensive care unit for the control of the acquired infection in respiratory tract in ICU.Methods The identification instrument from the French BioMérieux company was applied,1917 sputum samples were examined,900 cases of bacterium were detected.Results In the 900 samples of the pathogenic bacterium,718 cases（79.8%） were gram negative bacillus.47 cases（5.2%） were gram positive coccus and 135 cases（15.0%） were fungus.The detection rate of gram negative bacillus Pseudomonas aeruginosa and Burkholderia cepacia were 22.6% and 17.8%,respectively;the detection rate of gram positive coccus Staphylococcus aureus was 3.6%.Candida albicans was the most common pathogen of hospital acquired fungus infection,its detection rate was14.0%.Drug sensitivity test result shows that the main pathogenic bacterium was highly drug resistant and usually multi-drug resistant.Gram negative bacillus except the Stenotrophomonas maltophilia and Burkholderia cepacia were most sensitive to Carbapenems,and the drug resistant rate was less than 10%.Gram positive cocci lowest resistance rate of vancomycin was 0%.Fungi lowest resistance rate of common antifungal agents was 0%.Conclusion Most pathogenic bacteria of the acquired infection in respiratory tract in ICU were multi-drug resistant bacterium.Rational use of antibiotics should be carried out according to pathogenic and drug resistant data of pathogenic bacterium in order to control infections effectively and reduce new drug resistant bacterium.