67例急性呼吸窘迫综合征合并肺部感染的病原学分析  

Pathology of 67 Cases of Acute Respiratory Distress Syndrome Accompanying with Pulmonary Infection

作　　者：牛媛媛[1] 张常然[1] 曾勉[1] 李建锋[2] 汪建龙[1] 

机构地区：[1]中山大学附属第一医院呼吸内科,广东广州510700 [2]广州医学院附属第一医院放疗科,广东广州510120

出　　处：《中华医院感染学杂志》2010年第18期2866-2868,共3页Chinese Journal of Nosocomiology

摘　　要：目的分析急性呼吸窘迫综合征(ARDS)合并肺部感染的病原菌及对抗菌药物耐药情况。方法对2000年1月-2009年12月医院内科ICU收治的67例ARDS合并肺部感染患者行外周血检测和痰分离培养,并对分离出的病原菌进行药物敏感试验。结果 67例患者中巨细胞病毒(CMV)感染的有46例;培养出细菌71株,其中革兰阳性菌有37株,葡萄球菌属31株,以耐甲氧西林凝固酶阴性葡萄球菌、耐甲氧西林金黄色葡萄球菌为主,对替考拉宁、万古霉素的耐药率约10.00%;革兰阴性菌株有34株,以鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌为主,对β-内酰胺酶抑制剂复合制剂的耐药率达50.0%、对氨基糖苷类的耐药率达65.0%,对碳青酶烯类的耐药率达70.0%;培养出真菌33株,其中白色假丝酵母菌24株,曲霉菌属9株,白色假丝酵母菌对氟康唑的耐药率达10.0%,对两性霉素B的耐药率达50.0%。结论根据ARDS合并肺部感染在病原学分布、菌群变迁及病原菌耐药等的特点,应注意结合药敏结果进行更有效的目标治疗。OBJECTIVE To analyze the pathogens and their antibiotic resistance in patients with acute respiratory distress syndrome（ARDS） accompanying with pulmonary infection.METHODS Peripheral blood detection,sputum isolation culture and antibiotic sensitivity test were performed on 67 patients with ARDS accompanying with pulmonary infection.RESULTS Forty-six patients were confirmed with cytomegalovirus infection,totally 71 strains of bacteria were cultured,including 37 strains of Gram-positive cocci and 34 strains of Gram-negative bacilli.There were 31 strains of Staphylococcus in Gram-positive strains,and the main were coagulase negative staphylococcus and meticillin-resistant Staphylococcus aureus.The resistant rates to teicoplanin and vancomycin were about 10.00%;the main Gram-negative strains were Acinetobacter baumannii,Pseudomonas aeruginosa and Klebsiella pneumoniae.The resistant rates to β-lactamase inhibitor were 50.0%,to aminoglycosides 65.0% and carbapenem 70.0%.There were 33 strains of fungicultured,including 24 strains of Candida and 9 strains of Aspergillus.The resistant rates of fungi to fluconazole were 10.0% and to amphotericin B 50%.CONCLUSION According to the characteristics of bacterial distribution,microflora change and bacterial resistance in patients with ARDS accompanying with pulmonary infection,the target treatment can be effectively carried out in accordance with antibiotic sensitivity.

关 键 词：急性呼吸窘迫综合症 肺部感染 病原学 抗菌药物 耐药率 

分 类 号：R378[医药卫生—病原生物学]