重症监护病房下呼吸道感染临床特点及病原菌耐药性分析  

Clinical characteristics of lower respiratory tract infection in intensive care unit and pathogen resistance

作　　者：高伟[1] 郑军廷[2] 

机构地区：[1]河北医科大学第三医院感控科,石家庄050051 [2]河北医科大学第三医院妇产科,石家庄050051

出　　处：《中国综合临床》2011年第4期367-371,共5页Clinical Medicine of China

基　　金：河北省卫生厅医学科学研究重点课题计划项目（20100093）

摘　　要：目的 了解重症监护病房（ICU）患者下呼吸道感染的临床特点和病原菌分布及耐药情况,为临床合理使用抗菌药物提供依据.方法 对2008年1月至2010年8月我院ICU发生下呼吸道感染患者的临床资料进行回顾性分析,对分离出的病原菌进行菌株鉴定,药敏试验采用琼脂扩散（K-B）法,结果依据CLSI（2007）标准判读.结果 ICU共收治患者509例,发生下呼吸道感染147例,下呼吸道感染发生率为28.9%（147/509）;分离出病原菌283株,其中主要为G-杆菌占86.9%,其他病原菌包括G＋球菌（7.4）%和真菌（5.7）%;最常见的病原菌依次为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、嗜麦芽寡养单胞菌、真菌、大肠埃希菌、金黄色葡萄球菌、洋葱伯克霍尔德菌等,分别占24.7%、20.5%、12.7%、6.4%、5.7%、5.3%、5.3%、4.6%;主要病原菌对多种抗菌药物耐药严重.结论 ICU下呼吸道感染的发生率高,G-杆菌是导致下呼吸道感染的主要病原菌,且对抗菌药物呈多重耐药.Objective To understand the clinical characteristics of lower respiratory tract infection,pathogenic distribution and drug resistance in intensive care unit to provide a basis for reasonable use of antibiotics. Methods From January 2008 to August 2010,the clinical data from our hospital ICU impatients of lower respiratory tract infection were retrospectively analyzed. The isolated strains were identified, the antibiotic susceptibility test was performed by K-B methods and the results were read according to CLSI 2007. Results There were 509 patients, 147 cases of lower respiratory tract infection were found. Lower respiratory tract infection rate was 28.9% （147/509）; 283 strains of pathogens had been isolated by culture and most of which were Gram negative bacilli（86. 9%）, the other pathogens included Gram positive cocci（7.4%） and fungi（5.7%）. The most common pathogens were Acinetobacter spp, Pseudomonas aeruginosa, Klebsiella pneumoniae,Stenotrophomonas oligotrophic aeromons, Fungi, Escherichia coli, Staphylococcus aureus, Burkholderia cepacia,etc,accounting for 24. 7% ,20. 5% ,12. 7% ,6. 4% ,5.7% ,5. 3% ,5.3% and 4. 6% ;The main pathogens were highly resistant to the most antibiotics. Conclusion ICU had a higher lower respiratory tract infection rate, Gram negative bacilli are the main pathogen, and showed the multi-drug resistance features to the antibiotics.

关 键 词：重症监护病房 下呼吸道感染 病原菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学]