重症监护患者下呼吸道标本主要病原菌的构成及耐药性分析  

Pathogen prevalence and antibiotic resistance regarding lower respiratory tract infections in intensive care unit

作　　者：林泉[1] 邱磷安[1] 王诗端[1] 池细弟[1] 

机构地区：[1]福建省南平市第一医院感染性疾病科,353000

出　　处：《中国感染与化疗杂志》2008年第3期219-221,共3页Chinese Journal of Infection and Chemotherapy

摘　　要：目的调查重症监护病房(ICU)患者下呼吸道标本主要病原菌的构成与耐药情况,为抗感染治疗提供依据。方法收集我院2006年1月1日—12月31日期间ICU患者下呼吸道标本分离的细菌,采用纸片扩散法(Kirby-Bauer法)进行药敏试验。判断按照2005年版CLSI标准。结果临床分离的336株细菌中,革兰阴性杆菌254株,占75.6%,革兰阳性球菌49株,占14.6%,真菌33株,占9.8%。主要病原菌的检出率依次是铜绿假单胞菌22.0%,鲍曼不动杆菌14.6%,金葡菌13.1%,肺炎克雷伯菌11.9%,白念珠菌9.8%,大肠埃希菌8.6%,嗜麦芽窄食单胞菌8.0%。铜绿假单胞菌、鲍曼不动杆菌对亚胺培南、头孢吡肟、头孢哌酮-舒巴坦耐药率较低。嗜麦芽窄食单胞菌对头孢哌酮-舒巴坦、左氧氟沙星、复方磺胺甲口恶唑较敏感;大肠埃希菌、肺炎克雷伯菌对亚胺培南高度敏感,两菌产ESBLs株的检出率分别为37.5%与45.0%。金葡菌中MRSA检出率为84.1%(37/44),未发现万古霉素耐药株。结论我院ICU患者呼吸道标本中不发酵糖革兰阴性菌、MRSA检出率高。肠杆菌科细菌对亚胺培南高度敏感。应加强细菌耐药性监测以指导临床抗感染治疗。Objective To investigate the distribution and resistance of common pathogens isolated from ICU patients with lower respiratory tract （LRT） infection. Methods LRT isolates were collected from ICU patients during the period from January 1 to December 31 in 2006. The bacterial susceptibility testing was done by Kirby-Bauer method. The results were analyzed according to CLSI 2005. Results Of the 336 isolates, gram-negative bacilli, gram-positive cocci and fungi accounted for 75.6% （n = 254）, 14.6% （n = 49） and 9.8% （n = 33） respectively. The most common pathogens were P. aeruginosa （22.0%）, A. baurnannii （14.60v） , S . aureus （13. 1%）, K. pneumoniae （11.9%） , C. albicans （9.80%） , E. coli （8.60%） , S. maltophilia （8.0%）. Relatively lower percentage of P. aeruginosa and A. baumannii was resistant to cefepime, cefoperazone-sulbactam or imipenem. Lower percentage of S. maltophilia was resistant to cefoperazone-sulbactam, levofloxacin, and SMZ-TMP. E. coli and K. pneumoniae were highly sensitive to imipenem. About 37.5% of E. coli isolates and 45.0% of K. pneumoniae isolates were ESBL producers. Methicillin resistance was identified in 84. 1% of S. aureus isolates. None of S. aureus isolates was resistant to vancomycin. Conclusions The prevalence of non-fermentative gram-negative bacilli and MRSA is high. Enterobacteriaceae isolates are highly susceptible to imipenem. Antimicrobial agents should be rationally used according to the results of susceptibility testing.

关 键 词：重症监护病房 下呼吸道标本 病原菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学]