RICU患者下呼吸道感染的病原菌分析

Pathogens causing lower respiratory tract infections in RICU

目的探讨呼吸科重症监护病房(RICU)与普通病房下呼吸道感染的病原菌分布,并对比两个病房病原菌的耐药性,为临床合理应用抗菌药物提供参考。方法对呼吸科普通病房和RICU收治的364例下呼吸道感染的患者进行痰液培养,采用琼脂扩散法进行病原菌药敏试验,对比两个病房的病原菌分布及耐药性。结果普通病房共分离出病原菌451株,其中革兰阴性菌274株占60.75%,革兰阳性菌90株占19.96%,RICU共分离出病原菌278株,其中革兰阴性菌210株占75.54%,革兰阳性菌35株占12.59%,两个病房中均以革兰阴性菌感染为主,排前3位依次为铜绿假单胞菌、鲍氏不动杆菌、肺炎克雷伯菌;铜绿假单胞菌和肺炎克雷伯菌对亚胺培南、舒巴坦、阿米卡星较敏感,耐药率<50.0%,RICU铜绿假单胞菌的耐药率明显较高。结论与普通病房相比,RICU中病原菌分布及耐药性均较高,革兰阴性菌是感染的主要致病菌,临床上应根据病原菌分布及其耐药性合理使用抗菌药物。

OBJECTIVE To explore the distribution of pathogens causing lower respiratory tract infections in respir-atory intensive care units （RICUs）and common wards and compare the drug resistance of the pathogens so as to provide guidance for the reasonable clinical use of antibiotics.METHODS A total of 364 patients with lower respir-atory tract infections who were treated in the common respiratory wards and RICUs were enrolled in the study,the sputum culture was performed,the drug susceptibility testing was performed by using agar diffusion method,and the distribution and drug resistance of the pathogens were observed and compared between the two types of wards. RESULTS Totally 451 strains of pathogens have been isolated from the common wards,including 274 （60.75%） strains of gram-negative bacteria and 90 （19.96%）strains of gram-positive bacteria;278 strains of pathogens have been isolated from the RICUs,including 210 （75.54%）strains of gram-negative bacteria and 35 （12.59%）strains of gram-positive bacteria;the gram-negative bacteria were dominant in both types of wards;the Pseudomonas aeruginosa,Acinetobacterbaumannii,and Klebsiella pneumoniae ranked the top three species of pathogens.The drug resistance rates of the P.aeruginosa and K.pneumoniae to imipenem,sulbactam,and amikacin were less than 50.0%;the drug resistance rate of the P.aeruginosa isolated from the RICUs was significantly high. CONCLUSION As compared with the common wards,both the distribution and the drug resistance rates of the pathogens isolated from the RICUs are higher.The gram-negative bacteria are the predominant pathogenic bacteria causing the infections,and it is necessary for the hospital to reasonably use antibiotics on the basis of the distribu-tion and drug resistance of the pathogens.