绍兴市重症肺炎患者病原菌分布及耐药性分析

Analysis of distribution and drug resistance of the pathogens of severe pneumonia in intensive care unit of Shaoxing

目的 分析2014年1月-2015年12月间我院重症监护病房中重症肺炎患者病原菌的分布及细菌耐药性,为指导临床合理用药提供依据。方法 采用VITEK-32全自动微生物分析鉴定仪对重症肺炎患者呼吸道分泌物痰标本进行菌种鉴定,应用K-B药敏纸片扩散法进行药物敏感试验,数据采用Excel软件统计分析。结果293例重症肺炎患者痰标本共检出病原菌342株,包括106株（30.99%）革兰阳性菌,206株（60.23%）革兰阴性菌和30株（8.77%）真菌。最常见的革兰阳性菌和革兰阴性菌分别为金黄色葡萄球菌34株（9.94%）和鲍氏不动杆菌60株（17.54%）。万古霉素对革兰阳性菌高度敏感,美罗培南、亚胺培南对革兰阴性菌最敏感。结论 我院重症监护病房的重症肺炎病原菌以革兰阴性菌为主,应密切监测细菌耐药性变化及合理使用抗菌药物。

Objective To investigate the distribution and antibiotic resistance of pathogens causing severe pneumonia in intensive care unit （ICU） of our hospital from January 2014 and December 2015. It would provide the guidance for reasonable clinical use of antibiotics. Methods The distribution and identification of pathogens from sputum specimens of severe pneumonia patients were analyzed retrospectively by VITEK-32 automated microbial identified system, and the antibiotic resistance test was analyzed by the K-B disk diffusion method. And the Excel software was used for data analysis. Results A total of 342 strains causing severe pneumonia had been isolated from 293 sputum samples. In all pathogens, 106（30.99%） strains were gram-positive bacteria, 206（60.23%） strains were gram-negative bacteria and 30 （8.77%） strains were fungi. And the most common gram-positive and gram-negative bacteria were Staphylococcus aureus （34 strains, 9.94%） and Acinetobacter baumannii （60 strains, 17.54%） respectively. Vancomycin was highly sensitive against gram-positive bacteria; Meropenem and imipenem were most sensitive against gram-negative bacteria. Conclusion The gram-negative bacteria are the predominant pathogens causing severe pneumonia in ICU and are highly resistant. Antibiotic should be selected reasonably according to the etiology and drug resistance of bacteria in clinical work.