ICU医院获得性肺炎的病原菌分布及耐药性分析

Bacterial distribution and antibiotics resistance of hospital-acquired pneumonia in intensivecare unit

目的探讨ICU医院获得性肺炎的病原菌分布及其耐药性,指导临床合理用药。方法对我院2010年1月至2012年12月ICU医院获得性肺炎患者痰培养病原菌及其药敏结果进行回顾性分析。结果 ICU医院获得性肺炎的病原菌以革兰阴性菌为主,占89.06%,而革兰阴性菌中又以非发酵糖菌属及肠杆菌属多见,排在构成比前五位的细菌是肺炎克雷伯菌、铜绿假单胞菌、洋葱伯克霍尔德菌、鲍曼不动杆菌及阴沟肠杆菌,分别占21.09%、17.97%、14.06%、9.38%、9.38%;细菌对抗菌药物有不同程度的耐药率,头孢曲松及头孢噻肟的耐药率高,头孢吡肟次之,而亚胺培南以及哌拉西林/他唑巴坦的敏感性高。哌拉西林/他唑巴坦对肺炎克雷伯菌、铜绿假单胞菌、洋葱伯克霍尔德菌的敏感性优于亚胺培南。结论ICU医院获得性肺炎的病原菌以非发酵糖菌占优势。哌拉西林/他唑巴坦可能适合于医院获得性肺炎的早期经验性治疗。

Objective To investigate the pathogens distribution and antibiotics resistance of hospitalacquired pneumonia（HAP） in intensive care unit（ICU） and instruct clinical application of antibiotics reasonably. Methods To analyze the pathogens and antibiotics resistance of HAP in ICU during Jan 2010 to Dec 2012 retrospectively. Results The pathogenic bacteria mainly consisted of Gram-negatives （89.06%）, among which non-fermenting gram-negative bacteria and enterobacillus were the most frequent. The first five predominant species were Klebsiella pueumoniae, Pseudomonas aeruginosa, Burkholderia cepacia, Acinetobacter banmannii and Enterobacter cloacae, accounted for 21.09%, 17.97%, 14.06%, 9.38% and 9.38%, respectively. The bacteria showed different antibiotic resistance rate, the resistance of ceftriaxone and cefotaxime were high, second was cefepime, but the sensitivity of imipenem and piperacillin/tazobactam were high. The sensitivity of piperacillin/tazobactam to Klebsiella pneumoniae, Pseudomonas aeruginosa and Burkholderia cepacia was better than imipenem. Conclusions HAP is caused predominantly by non-fermenting gram-negative bacteria. Piperacillin/tazobactam might be appropriate to use as initial empiric therapy for HAP.