ICU患者下呼吸道院内感染的细菌种类及其耐药性研究

Study of bacterial species and drug resistance of lower respiratory tract infection in ICU patients

目的：研究ICU患者下呼吸道院内感染的细菌种类及其耐药性，为ICU患者下呼吸道院内感染的诊断与治疗提供依据。方法选择2014年1-12月入住成都医学院第一附属医院ICU且发生下呼吸道院内感染的患者148例，采集其痰液标本，进行细菌分离鉴定与药敏实验，统计并分析其下呼吸道院内感染的细菌种类及其耐药性。结果所有148例下呼吸道院内感染患者痰标本经实验室培养鉴定，检出病原菌185株，其中，真菌15株（8.11%），细菌170株（91.89%）。革兰阴性菌141株（82.94%），革兰阳性菌29株（17.06%）。在所有检出的病原菌中，位居前3位的革兰阴性菌依次为肺炎克雷伯菌（28.82%）、铜绿假单胞菌（18.24%）、嗜麦芽窄食单胞菌（9.92%）。检出革兰阳性菌中金黄色葡萄球菌数量最多，约为所有检出革兰阳性菌的79.31%。革兰阴性菌、革兰阳性菌对于抗生素多具有耐药性，且多数菌株为多重耐药菌株。结论及时检测ICU下呼吸道院内感染的细菌种类，动态监测细菌耐药情况，按照患者感染细菌种类以及药物敏感情况进行积极有效的治疗，能够促进患者转归，改善患者生命质量。

Objective To study the bacteria species and drug resistance of lower respiratory tract nosocomial infection in ICU patients and provide the basis for the diagnosis and treatment for the ICU patients with lower respiratory tract nosocomial infection. Methods 148 ICU patients with lower respiratory tract nosocomial infection in Department of Critical Care Medicine, the First Affiliated Hospital of Chengdu Medical College from January to December 2014 were selected and collected the sputum samples for separating and identifying the bacteria and drug sensitive to analyze the bacteria species and drug resistance of lower respiratory tract nosocomial infection. Results 185 strains of pathogens were detected from 148 cases of sputum samples with lower respiratory tract nosocomial infection by laboratory cultiva-tion and identification. Among the detected strains, there were 15 strains of fungus strains （8.11%）, 170 strains of bac-teria （91.89%）; 141 strains of gram-negative bacteria （82.94%） and 29 strains of gram-positive bacteria （17.06%）. The top three of detected gram-negative bacteria were Klebsiella pneumoniae （28.82%）, Pseudomonas aeruginosa （18.24%）, and Stenotrophomonas maltophilia （9.92%）. The count of Staphylococcus aureus （79.31%） was the largest pathogens in the detected gram-positive bacteria. Most of gram-negative bacteria and gram-positive bacteria were resistant to an-tibiotics, and most of strains were multi-drug resistant. Conclusion Detecting bacterial species of the ICU patients with lower respiratory tract nosocomial infection timely, monitoring bacterial resistance dynamically and treating the patients based on bacteria species of infected and drug sensitive effectively, can promote the patient outcomes and improve the quality of life.