ICU病人医院内获得下呼吸道感染病原菌分布及耐药性

HOSPITAL ACQUIRED LOWER RESPIRATORY TRACT INFECTION IN INTENSIVE CARE UNIT PATIENTS:ITS PATHOGENIC BACTERIA DISTRIBUTION AND DRUG RESISTANCE

目的探讨本院重症监护病房(ICU)病人医院内获得下呼吸道感染的病原菌分布及耐药情况,为临床控制下呼吸道感染提供依据。方法收集2014年本院ICU医院内获得下呼吸道感染病人下呼吸道相关标本的细菌培养和药敏结果,分析其病原菌分布及耐药情况。结果 326例医院内获得下呼吸道感染病人共检出病原菌483株,其中革兰阴性菌351株(72.7%),革兰阳性菌48株(9.9%),真菌84株(17.4%);检出率前4位的是鲍曼不动杆菌(21.7%)、铜绿假单胞菌(18.9%)、肺炎克雷伯菌(13.9%)及白假丝酵母菌(12.2%)。革兰阴性菌对哌拉西林、头孢曲松、头孢噻肟、头孢他啶耐药率较高,对亚胺培南、美罗培南、头孢哌酮-舒巴坦耐药率较低;金黄色葡萄球菌对大部分抗菌药物耐药率较高;真菌耐药率普遍较低。结论本院ICU医院内获得下呼吸道感染病原菌以革兰阴性菌为主,耐药性较严重,应及时监测病原菌分布及耐药性,合理应用抗菌药物,以减少耐药菌的产生,降低医院感染的发生率。

Objective To investigate the distribution and drug resistance of pathogens causing nosocomial lower respiratory tract infection（LRTI）in intensive care unit（ICU）patients of our hospital and provide reference for its control. Methods The results of the bacterial culture and drug sensitivity of patients in ICU,in 2014,with nosocomial infection of LRTI in our hospital were collected,the distribution and drug resistance of the pathogens analyzed. Results A total of 483 strains of pathogenic bacteria were detected in 326 patients with LRTI.In which,351（72.7%）strains were Gram-negative,48（9.9%）Gram-positive,and 84（17.4%）were fungus;the detection rate of the top four was Acinetobacter baumannii（21.7%）,Pseudomonas aeruginosa（18.9%）,K.pneumoniae（13.9%）and C.albicans（12.2%）.Gram-negative bacteria had high resistance to piperacillin,ceftriaxone,cefotaxime and ceftazidime,and low resistance to imipenem,Meropenem and Cefoperazone/sulbactam.S.aureus had a high resistance to most of the antimicrobial drugs,while fungus resistance was generally low. Conclusion Gram-negative bacteria are the main pathogens of lower respiratory tract infection found in ICU patients in our hospital,the distribution and drug resistance of pathogenic bacteria should be timely monitored,and rational use of antimicrobial agents be carried out in order to reduce the production of drug-resistant bacteria and the incidence of nosocomial infection.