ICU与非ICU患者下呼吸道医院感染病原菌分布及耐药性分析

Distribution and drug resistance of pathogens causing lower respiratory tract infections in ICU and non-ICU patients

目的分析ICU与非ICU患者医院下呼吸道感染病原菌分布和耐药性,为提高临床抗感染治疗水平提供依据。方法回顾性分析3年ICU与非ICU医院下呼吸道感染病原菌分布及其耐药性,对其进行统计分析。结果医院下呼吸道感染ICU组以非发酵菌为主,占总病原菌38.2%,非ICU组以肠杆菌科细菌及真菌为主,分别占总病原菌29.2%、32.3%;共分离出病原菌514株,革兰阴性杆菌318株占61.9%,其次为真菌166株占32.3%,革兰阳性球菌30株占5.8%;ICU组感染鲍氏不动杆菌及嗜麦芽寡养单胞菌的检出率高于非ICU组,非ICU组感染真菌高于ICU组;ICU组和非ICU组鲍氏不动杆菌对常用抗菌药物耐药率分别为环丙沙星87.8%、62.9%,哌拉西林/他唑巴坦53.2%、22.9%,头孢他啶91.8%、60.9%,亚胺培南/西司他丁32.7%、25.7%,头孢哌酮/舒巴坦12.2%、6.0%。结论临床应根据药敏结果合理使用抗菌药物,可减少耐药菌株产生。

OBJECTIVE To analyze the distribution and drug resistance of the pathogens causing lower respiratory tract infections in the ICU and non-ICU patients so as to provide basis for improving the leuel of auti-imfeltion therapg. METHODS The distribution and drug resistance of the pathogens causing lower respiratory tract infections in the ICU and non-ICU in three years were retrospectively analyzed and then were taken for statistical analysis. RESULTS The main pathogens causing nosocomial lower respiratory tract infections were non-fermenting bacteria in ICU, accounting for 38.2 %;Enterobacteriaceae and fungi were the main pathogens in the non-ICU, accounting for 29.2% and 32.3%. Totally 514 strains of pathogens were isolated, including 318 （61.9%） strains of gram-negative bacilli, 166 （32. 3%） strains of fungi, and 30 （5.8%） strains of gram-positive coccci. The number of the cases with Acinetobacter infections and Stenotrophomonas maltophilia infections in the ICU was more than that in the non-ICU, but the cases with fungal infections in the non-ICU were more than that in the ICU. The drug resistance rates of A. baumannii strains in the ICU and non-ICU to ciprofloxacin were 87.8% and 62.9%, piperacillin-tazobaetam （53. 2% and 2. 9% ）, ceftazidime （91.8% and 60. 9%） ,imipenem-cilastatin （32.7% and 25.7%） , cefoperazone-snlbactam （12.2% and 6.0%）, and meropenem （42.9% and 8.6%）. CONCLUSION Only in this way to use antibiotics based on the result of the drug susceptibility testing can the drug resistant strains be reduced.