2012—2015年阿坝州人民医院重症监护病房下呼吸道感染病原菌的分布及耐药性分析

Analysis on distribution and drug resistance of pathogenic bacteria causing lower respiratory tract infection in Intensive Care Unit of People's Hospital of Aba Prefecture from 2012 to 2015

目的分析阿坝州人民医院重症监护病房下呼吸道感染病原菌的分布及耐药性,为临床合理用药提供参考。方法对2012年1月—2015年12月阿坝州人民医院重症监护病房分离下呼吸道感染病原菌的分布及药敏结果进行回顾性分析。结果共分离出病原菌192株,其中革兰阴性菌124株,占64.6%,主要为铜绿假单胞菌、肺炎克雷伯菌、流感嗜血杆菌和鲍曼不动杆菌。革兰阳性菌56株,占29.1%,主要为金黄色葡萄球菌和肠球菌。真菌12株,占6.3%。主要革兰阴性菌对氨苄西林、亚胺培南都较为敏感。铜绿假单胞菌和鲍曼不动杆菌对青霉素类、第2、3代头孢菌素类耐药率较高;肺炎克雷伯菌和流感嗜血菌对第2、3代头孢菌素类耐药率较高。革兰阳性菌对万古霉素、替加环素都较为敏感;金黄色葡萄球菌对青霉素G耐药率较高;肠球菌对利奈唑烷耐药性高。白色念球菌和白色假丝酵母菌对氟康唑、伊曲康唑和两性霉素敏感率较高。结论阿坝州人民医院重症监护病房下呼吸道感染病原菌以革兰阴性菌为主,高海拔地区患者易产生多重耐药性菌株,临床应及时了解病原菌分布及耐药情况,合理使用抗菌药物。

Objective To analyze the distribution and drug resistance of pathogenic bacteria causing lower respiratory tract infection in Intensive Care Unit of People＇s Hospital of Aba Prefecture, and to provide reference for rational drug use in clinic. Methods The distribution and drug resistance of pathogenic bacteria causing lower respiratory tract infection in Intensive Care Unit of People＇s Hospital of Aba Prefecture from January 2012 to December 2015 were analyzed retrospectively. Results Total 192 strains of pathogens were isolated, in which Gram-negative bacteria were 124 strains（64.6%）, main of them were Pseudomonas aeruginosa, Klebsiella pneumoniae, Haemophilus influenzae, and Acinetobacter baumannii. Gram-positive bacteria（56 strains） accounted for 29.1%, main of them were Staphylococcus aureus and Enterococcus faecalis. While there were also 12 strains of fungus（6.3%） isolated. Most Gram-negative bacteria were more sensitive to ampicillin and imipenem. The resistance rate of P. aeruginosa and A. baumannii against penicillins and the second and third generation was higher. And the resistance rate of K. pneumoniae and H. influenzae against the second and third generation was higher. Gram-positive bacteria were more sensitive to vancomycin and tigecycline. The resistance rate of S. aureus against penicillin G was higher. And the resistance rate of E. faecalis against linezolid was higher. The sensitive rate of Tritirachium album and Candida albicans against fluconazole, itraconazole, and amphotericin was higher. Conclusion The main pathogens causing lower respiratory tract infection in Intensive Care Unit of People＇s Hospital of Aba Prefecture is Gram-negative bacteria, and patients with high altitude are prone to multiple drug-resistant strains. The physician should understand local pathogenic bacteria distribution and drug resistance timely, in order to guide the clinical empirical use of antibacterial drugs.