重症监护病房下呼吸道感染病原菌分布及耐药性分析  

Distribution of the pathogens and their drug resistance in patients with lower respiratory tract infection in Intensive Care Unit

作　　者：张敏[1] 邓哲彤[1] 叶小玲[1] 洪城[1] 张锐[1] 黎宝红[1] 赵蔚诗[1] 江颖仪[1] 冯志顺[1] 

机构地区：[1]暨南大学第四附属医院广州市红十字会医院ICU,广州510220

出　　处：《中国实用内科杂志》2009年第11期997-999,共3页Chinese Journal of Practical Internal Medicine

基　　金：广东省卫生厅资助(A2008537);广州市医药卫生科技项目(2007-YB-040)

摘　　要：目的了解重症监护病房(ICU)下呼吸道感染病原菌分布及耐药情况,为临床用药提供参考。方法对2007年1月至2008年12月ICU220例下呼吸道感染患者阳性痰培养及药物敏感度结果进行分析。结果220例患者分离出菌株280株。革兰阴性(G-)菌178株,占63.5%,前4位分别为肺炎克雷伯菌(17.1%)、铜绿假单胞菌(13.2%)、鲍曼不动杆菌(12.5%)和嗜麦芽窄食单胞菌(10.4%);革兰阳性(G+)菌70株,占25.1%,耐甲氧西林金黄色葡萄球菌(MRSA)63株;真菌32株,占11.4%,以白色念珠菌为主。对铜绿假单胞菌敏感度在65%以上的有美罗培南、亚胺培南、阿米卡星、头孢哌酮/舒巴坦。肺炎克雷伯菌和鲍曼不动杆菌对美罗培南、亚胺培南具有高敏感度;嗜麦芽窄食单胞菌对左氧氟沙星敏感度较高。MRSA对万古霉素敏感度为100%。结论ICU下呼吸道感染病原菌以G-菌为主,其中肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌和嗜麦芽窄食单胞菌构成主要感染菌株;亚胺培南、美罗培南仍然是控制G-杆菌感染的最有效药物,但应注意到相当数量对亚胺培南、美罗培南耐药菌株的出现;MRSA感染比例有所增高,万古霉素仍是十分有效的选择。Objective To investigate pathogens and drug resistance of lower respiratory tract infection（LRTI） in Intensive Care Unit （ICU）. Methods Retrospective study of the clinical data, the distribution and the drug-sensitivity of pathogens of 220 cases with LRTI in ICU. Results Totally 280 strains of pathogens were identified by bacterial culturing. The ratio of G- bacteria to total pathogens isolated was 63.5% ,of the G＋ bacteria was 25.1% ,and of the fungi was 11.4%. The main kinds of the G- bacteria were Klebsiella pneumoniae （ 17. 1% ）, Pseudomonas aeruginosa（ 13.2% ）, Acinetobacter baumannii （ 12. 5 % ）, and Stenotrophomonas maltophilia （ 10. 4 % ）. Staphylococcus aureus （ SA ） （ 91.4 % ） was the most prominent in G＋ bacteria, and MRSA was 98.4% in SA. The result of drug sensitive test in vitro showed the multiple drug fast rate of Pseudomonas aeruginosa was comparatively high, Stenotrophomonas maltophilia to Levofloxacin was low, Klebsiella pneumoniae and Aeinetobacter banmannii were highly sensitive to carbapenems. The susceptibility rate of MRSA to vaneomycin was 100%. Conclusion G- bacteria are the majority of the pathogens,isolated from patients with LRTI in ICU. Klebsiella pneumoniae, Pseudomonas aeruginosa, Aeinetobaeter banmannii, and Stenotrophomonas maltophilia are the chief G-pathogens. Except Stenotrophomonas maltophilia, imipenem and merpenem are relatively active against the G-bacilli. The proportion of MRSA and fungal infection is increasing. It is suggested that there be urgent need for surveillance of bacterial resistance and rational use of antimicrobial agents during clinical therapy.

关 键 词：重症监护病房 下呼吸道感染 病原菌 耐药率 

分 类 号：R5[医药卫生—内科学]