重症监护病房呼吸道感染常见致病细菌的耐药性调查

Investigation of drug resistance status of pathogenic bacteria of respiratory tract infection in ICU

目的 调查我院重症监护病房 ( ICU )引起呼吸道感染的致病菌菌群分布及其耐药情况。方法 将 2 0 0 0年 5月～ 2 0 0 3年 9月我院重症监护病房送检的呼吸道标本中接种于血培养基和巧克力培养基 ,分离出的致病菌用 VITEK AMS- 6 0鉴定 ,药敏用 K- B法。结果 共分离出 4 94株致病细菌 ,其中革兰氏阴性杆菌30 7株占 6 2 .1% ,革兰氏阳性球菌 187株占 37.9%。革兰氏阴性杆菌中铜绿假单胞菌 12 2株 ,肺炎克雷伯氏菌和大肠埃希氏菌 5 2株 ,鲍氏不动杆菌 4 4株 ,嗜麦芽寡养单胞菌 2 7株 ,阴沟肠杆菌 2 3株。革兰氏阳性球菌 187株 ,其中金黄色葡萄球菌 115株 ,凝固酶阴性葡萄球菌 5 2株 ,粪肠球菌 14株。药敏试验结果提示各主要致病革兰氏阴性杆菌对亚胺培南、头孢哌酮 /舒巴坦、头孢他啶敏感性较高 ;各主要致病革兰氏阳性球菌对万古霉素、替考拉宁、氯霉素的敏感性较高。结论 铜绿假单胞菌是引起我院重症监护病房病人呼吸道感染的主要致病革兰氏阴性杆菌 ,金黄色葡萄球菌为主要致病革兰氏阳性球菌。各主要致病菌均耐药严重且呈多重耐药 ,提示合理运用抗生素 ,对提高临床治疗效果 ,有效控制病人的感染尤为关键。

Objective To investigate the distribution and drug resistance of pathogenic bacteria which caused respiratory infection in ICU. Methods Sputum collected in ICU from May 2000 to September 2003 were inoculated into blood media and chocolate media. Pathogenic bacteria were identified with VITEK AMS 60, drug susceptible tests used K B method. Results Totally 494 strains of bacteria were isolated, 307 strains of Gram negative bacilli and 187 strains of Gram positive cocci account for 62 1% and 37 9% respectively. Three and seven strains of Gram negative bacilli were isolated including 122 stains of Pseudomonas aeruginosa , 52 strains of Klebsiella pneumonia and Escherichia coli , 44 strains of Acinetobacter baumannii , 27 strains of Stenotrophomonas maltophilia , 14 strains of Enterobacter cloacae . One hundred and eighty five strains of Gram positive cocci were isolated including 115 strains of Staphylococcus aureus , 61 strains of Coagulase negative Staphylococcus , 14 strains of Enterococcus faecalis . Drug susceptible tests suggested that the dominant Gram negative bacilli were more sensitive to imipenem, cefoperazone/sulbactum, ceftazidime, the dominant Gram positive cocci were sensitive to vancomycin, teicoplanin, and chloramphenicol. Conclusions Pseudomonas aeruginosa predominated in Gram negative bacilli and Staphylococcus aureus predominated in Gram positive cocci which caused respiratory tract infection in ICU. The pathogenic bacteria presented multiple drug resistance. It suggested that antibiotics must be rationally used in order to enhance clinical therapeutic efficacy and control infection effectively.