重症监护病房院内肺部感染病原菌分析

Bacteria of Nosocomial Pulmonary Infection in Intensive Care Unit

目的 :研究我院ICU病房院内肺部感染 (NP)病原菌特点及其耐药性监测。方法 :对 2 0 0 0年 7月至 2 0 0 2年 7月在我院ICU住院 3d或 3d以上的 2 0 3例病人的NP发生率、病原菌特点及药物敏感试验结果进行回顾性分析。结果 :2 0 3例病人的NP发生率为 2 6 .1% ,NP发生率与住院时间呈正相关 (P <0 .0 1)。分离培养出病原菌 135株 ,G-菌占 6 9.6 % ,G+ 菌占 2 3% ,真菌占 7.4 %。出现频率位于前 6位的病原菌依次为铜绿假单胞菌、金黄色葡萄球菌、大肠埃希菌、肺炎克雷伯杆菌、鲍曼 /溶血不动菌和阴沟肠杆菌。共有 5 3株细菌产超广谱 β内酰胺酶 (ESBL) ,占细菌总数的 4 2 .4 %。ESBL的产生率与住院时间呈正相关 (P <0 .0 5 )。大部分细菌呈现出多重耐药性。对G+菌敏感的药物主要为万古霉素、利福平、四环素和复方新诺明。对G-菌相对敏感的主要有丁胺卡那霉素、菌克单、复达欣、亚胺培南和氧派秦青霉素 /他唑巴坦。结论 :ICU病房NP的发生率较高。病原菌以G-菌为主。铜绿假单孢菌居首位 ,金黄色葡萄球菌居第二。大部分病原菌呈现多重耐药性 。

Objective: To study the causative organisms and the drug resistance of nosocomial pulmonary infection(NP)in intensive care unit(ICU).Methods:The morbidity of NP in 203 patients who had stayed in ICU for 3 days or more during the period from July 2000 to July 2002 was analyzed retrospectively. The pathogens'spectrum and their resistance profiles were analyzed also. Results: Among the 203 patients,53 of them developed nosocomial pulmonary infection once at least and the morbidity was 26.1%(53/203).The hospitalization time was directly related to the morbidity (r=0.39, P <0.01).In 135 strains of pathogens from 39 of 53 NP patients, the percentage of G - bacteria,G + bacteria, and fungi were 69.6%,23%,and 7.4% respectively.Among all the pathogens,Pseudomonas aeruginosa was the most predominant,Staphylococcus aureus was the second one, followed by Escherichia coli,Klebsiella Pneumoniae,Acinetobacter baum/haemolyticus and Enterobacter cloacae in turn. 50 of 125 strains of bacteria produced ESBL.The percentage was 42.4%.But there was no statistically significant difference between the two percentages to produce ESBL.Most of the bacteria were multiple resistant to the tested antimicrobial. Vancomycin, Rifampin,Tetracycline, and SMZ TMPCo were relatively sensitive to the G + bacteria and all the other tested antimicrobial worked extremely poor on them.The relatively effective antibiotics against G -bacteria mainly including Amikacin,Aztreonam,Ceftazidime,Imipenem,and Piperacillin/Tazobactam.These G -bacteria showed highly resist to the other tested antimicrobial.Conclusion:The morbidity of NP was relatively high in ICU,G -bacteria was the dominant causative pathogens.Among all the pathogens,the pseudomonas aeruginosa was the most major one, following it was staphylococcus aureus. Most of the pathogens were multiple resistant.ESBL production is one of the major causes.