呼吸监护病房痰培养结果分析与对策  

Sputum Cultures in Respiratory Care Unit and Countermeasures

作　　者：翟红岩[1] 安海英[1] 蒋静[1] 秦艳红[1] 张白瑜[1] 

机构地区：[1]解放军第307医院感染管理科,北京100071

出　　处：《中华医院感染学杂志》2010年第24期4022-4024,共3页Chinese Journal of Nosocomiology

摘　　要：目的对呼吸重症监护病房患者痰培养进行调查与分析,为控制呼吸重症监护病房耐药菌感染治疗提供依据和对策。方法按《医院消毒技术规范》要求采样,参照《医院感染诊断标准》诊断病例。结果多药耐药鲍氏不动杆菌、铜绿假单胞菌、产ESBLs阳性革兰阴性菌、耐甲氧西林金黄色葡萄球菌、耐高浓度氨基糖苷类屎肠球菌检出率分别为87.3%、60.0%、38.2%、21.8%、5.5%,已经成为呼吸重症监护病房主要的定植菌和流行菌;55例痰培养阳性患者共检出细菌102株,检出的前5位细菌分别为鲍氏不动杆菌(25.5%)、铜绿假单胞菌(23.5%)、金黄色葡萄球菌(10.8%)、嗜麦芽寡养单胞菌(6.9%)、阴沟肠杆菌(6.9%)、鲍氏不动杆菌只对米诺环素、头孢哌酮/舒巴坦和妥布霉素有较好敏感性,其他常用抗菌药物敏感性均<20.0%,铜绿假单胞菌对亚胺培南的敏感性为37.5%,对美罗培南的敏感性为29.2%。结论制定合理、科学、规范的抗菌药物使用制度,减少对病原菌耐药的抗菌药物压力;按照隔离传染源、切断传染途径和保护易感者的原则对耐药菌感染患者实行隔离治疗和护理;严格执行预防呼吸机相关性肺炎的管理等措施达到控制耐药菌传播和暴发。OBJECTIVE To investigate and analyze the patients＇ sputum cultures in respiratory care unit,to provide countermeasure for controlling the infection of drug resistant bacteria in respiratory care unit.METHODS The sample collection was conducted according to Criterion of the Sterilization Technique in Hospital,the cases was diagnosed according to Criterion of Infection and Diagnosis in Hospital.RESULTS Multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa,methicillin-resistant Staphylococcus aureus（MRSA）,Gram-negative bacteria with ESBL positive and Stenotrophomonas maltophilia were the most colonizing and popular bacteria with the respectively detected rates of 87.3%,60.0% 38.2%,21.8% and 5.5%.A total of 102 strains of bacteria were detected from 55 cases of negative sputum culture,the top 5 detected bacteria were ABA（25.5%）,PAE（23.5%）,S.aureus（10.8%）,PMA（6.9%）,E.cloacae（6.9%） and E.coli（4.9%）;ABA had a good sensitivity to minocycline,cefoperazone/sulbactam and tobramycin,and the sensitivity to other common antibiotics were less than 20.0%.The sensitivity of PAE to imipenem was 37.5% and to meraopenem was 29.2%.CONCLUSION Scientific and regular rules can reduce the pressure of bacteria-resistant antibiotics.Isoation of the patients with resistant pathogens aimed to isolate the source of infection,cut of the trans mission of the infection and protect the susceptible population.Executing the rules of prevention of the ventilator-associated pneumonia strictly is aimed to control the transmission and outbreaks of the drug-resistant bacteria.

关 键 词：呼吸重症监护病房 耐药菌 痰培养 措施 

分 类 号：R378[医药卫生—病原生物学]