ICU患者下呼吸道感染病原菌分布及耐药性分析

Analysis of distribution and drug resistance of pathogenic bacteria in patients with lower respiratory tract in-fection in ICU

目的：了解ICU患者下呼吸道感染病原菌的分布及其耐药性，为临床合理用药提供科学参考依据。方法采用VITEK-32全自动细菌鉴定仪进行菌种鉴定，用K-B药敏纸片扩散法测定细菌敏感性，使用WHONET 5．4软件进行统计学分析。结果 ICU患者下呼吸道感染病原菌中，共检出453株病原菌，革兰阴性菌332株占73．3％，前三位依次为铜绿假单胞菌115株占25．4％，肺炎克雷伯菌90株占19．8％，鲍氏不动杆菌38株占8．4％；革兰阳性菌102株占22．5％，前三位依次为金黄色葡萄球菌31株占6．8％，凝固酶阴性葡萄球菌22株占4．9％，肠球菌属18株，占4．0％。美罗培南、亚胺培南（嗜麦芽寡养单胞菌除外）和头孢哌酮／舒巴坦、阿米卡星对革兰阴性菌最敏感，替考拉宁和万古霉素对革兰阳性菌高度敏感。结论 ICU患者下呼吸道感染病原菌以革兰阴性杆菌为主，对常用抗菌药物耐药严重，加强对ICU的感染管理及危险因素控制，合理使用抗菌药物，降低病原菌的耐药率具有重要意义。

Objective To investigate the distribution and drug resistance of pathogenic bacteria in hospital ICU patients with lower respiratory tract infection , and provide scientific reference for clinical rational drug use . Methods The strains were identified by VITEK -32 automatic bacterial identification instrument , the bacterial sensitivity was determined by K -B disk diffusion method , and the statistical analysis was performed by WHONET 5.4 software.Results The total isolated pathogenic bacteria of lower respiratory tract infection in ICU patients was 453 strains.332 strains of gram negative bacteria accounted for 73.3%,and the former three ones were Pseudomonas aeruginosa （115 strains,accounted for 25.4%）,Klebsiella pneumonia （90 strains,accounted for 19.8%）,Acineto-bacter baumannii （38 strains,accounted for 8.4%）.102 strains of gram positive bacteria accounted for 22.5%,and the top three were Staphylococcus aureus （31 strains,accounted for 6.8%）,coagulase negative Staphylococcus （22 strains,accounted for 4.9%）,Enterococcus （18 strains,accounted for 4%）.Meropenem,imipenem （Stenotroph-omonas maltophilia was excepted ） ,Cefoperazone /sulbactam and Amikacin were most sensitive against gram negative bacteria;Teicoplanin and vancomycin were highly sensitive against gram positive bacteria .Conclusion The main pathogenic bacteria of respiratory tract infection in ICU patients was gram negative bacilli ,which were seriously resist-ant to commonly used antimicrobial drugs .So strengthening the infection management of ICU and the control for risk factors,and rationally using of antimicrobial drugs has great significance in reducing the drug resistance of pathogenic bacteria rate .