综合性ICU医院内肺炎58例细菌耐药分析

Analysis of 58 cases on bacterial resistance of nosocomial pneumonia in comprehensive ICU

目的 分析ICU医院内肺炎 (NP)菌群的分布及耐药特点 ,探讨临床防治对策。方法 回顾总结ICU1998年 2月～ 2 0 0 3年 2月NP的病原菌谱、耐药性及临床特征。结果 5 8例NP感染菌 15 9株中G-杆菌占 64 .78%、G+ 球菌占 2 2 .64 %、真菌占 12 .5 8%;G-杆菌以铜绿假单胞菌为主 ( 4 0 .0 8%) ,G+ 球菌主要为金黄色葡萄球菌 ( 90 .0 %) ,MRAS(耐甲氧西林金葡萄 )占金黄色葡萄球菌的 93 .5 %;产ESBL(超广谱 β内酰胺酶 )菌主要为肺炎克雷伯菌和大肠埃希菌 ;除嗜麦芽黄单胞菌外 ,G-杆菌对亚胺培南 /西司他丁、阿米卡星、哌拉西林 /舒巴坦、头孢他啶较敏感 ;产ESBL菌对亚胺培南 /西司他丁、MRSA对万古霉素皆有 10 0 %的敏感率。结论 NP感染以G-杆菌为主 ,对亚胺培南 /西司他丁敏感 ,为降低多重耐药菌和产ESBL菌的产生 ,对呼吸机的相关器械要严格消毒、定期更换 ,并严格控制第三代头孢菌素的使用。

Objective To investigate the bacterial spectrum of nosocomial pneumonia (NP) and characteristics of drug resistance in ICUand to evaluate the clinical preventive and therapeutic managments. Methods The bacterial spectrum from ICU and its drug resistanceand the clinical characteristics were retrospectively analysed during February 1998-February 2003. Results In 159 strains isolated from 58 cases with NP, the percentage rates of G - bacilus, Gram-positive bacteria and fungi were 64.78%, 22.64% and 12.58%, respectively. Among G - bacteria, Pseudomonasaeruginosa strains were the major ones (40.08%) and in G + cocci Staphylococcus aureus (SA) was the most prominent (90%) and MRSA was 93.5% in SA. The bacteria producing ESBL were mainly from E. coli and K. pneumoniae. Except Xanthomonas maltophilia strains, imipenem, amikacin, piperacilin/sulbactam ceftazidim were relatively active against the G - bacillus. The sensitive rate of ESBL producing strains to imipenem and MRSA to vancomycin were all 100%. Conclusion It was shown that the most prevalent isolates of pathogens of NP were G - bacteria which were the most sesntive to imipenem. In order to decrease the incidence of some multidrug-resistant organisms and producing ESBL bacteria,it is very important to sterilize thoroughly and timely ventilator and control rigorously the use of 3 rd generation cephalosporins.