重症监护病房下呼吸道感染病原茵耐药分析及对策  

Clinical surveillance of drug resistance and countermeasures in lower respiratory tract for ICU

作　　者：栗振[1] 赵安成[1] 

机构地区：[1]山东省临沂市沂水中心医院,山东沂水276400

出　　处：《医学检验与临床》2011年第5期15-17,共3页Medical Laboratory Science and Clinics

摘　　要：目的对重症监护病房下呼吸道感染患者痰培养进行调查与分析，为控制下呼吸道患者感染提供依据和对策。方法采用Ⅵ1EK60全自动微生物分析仪，对2010年lO月至20lO年12月重症监护病房收治65例病人的痰标本进行培养。结果共捡出病原茵182株，其中G一茵152株。G＋茵30株；G＋茵前六位的为铜绿假单胞茵、大肠埃希菌、阴沟肠杆菌、鲍氏不动杆茵、肺炎克雷伯杆茵、嗜麦芽窄食单胞茵，分别占22％、11％、9．3％、8．8％、7．1％、6．6％；G＋茵前三位的是金黄色葡萄球茵、D群链球菌和表皮葡萄球茵。分别占7．1％、6．6％和1．6％。G＋茵中铜绿假单胞茵耐药严重．大肠埃希茵、鲍氏不动杆菌、阴沟肠杆菌也普遍耐药严重，尤其近几年鲍氏不动杆菌耐药有上升趋势。金黄色葡萄球茵是感染最主要的G＋球茵，对苯唑西林耐药率高达76％，万古霉素仍是治疗金葡茵最敏感药物。结论制定科学、合理、规范的抗茵药物使用制度，减少对病原茵耐药的抗茵药物压力；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茵感染患者实行隔离治疗；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茵传播和聚集流行。Objective To investigate and analyze the sputum specimens adopted from lower respiratory tract in ICU to provide the rational usage of antibiotics in clinical practice. Methods Sputum specimens were collected from 65eases of patients in ICU from August to October 2010 cultured and analyzed by VITEK automatic analyzer. Result 182 strains pathogens were detected from the 65 specimens in which 152 strains were Gram - negative bacilli and 30 strains were Gram - positive bacilli. The frequent appearance Gram - negative bacilli were Pseu- domonas aeruginosa, Esehcrichia coli, Enterobacter cloacae, Acinetobacter bauroanii, Klebbsiella pneumoniae, and stenotrophomonas mal- tophilia accounting for 22 %, 11%, 9.3 %, 8.8 %, 7.1% and 6.6 % respectively ; comparatively, the most common Gram - positive bacilli were Staphyloeceeus aureus, D - streptococcus and Staphylococcus epidermidis accounting for 7.1% - 6.6 % and 1.6 % respectively. It re- vealed that Pseudomonas aeruginosa show manifest capacity of biotic resistance, the circumstances in Eschefichia coli, Acinetobacter baumanii and Enterobacter cloacae are very pepular either in Gram- negative bacilli. Staphylococcus aureusis was the most pathogen in Gram - positive bacilli infection and 76% cases showed resistance to prostaphlin, while still sensitive to vancomycin. Conclusion Scientific and systematic in- stitutions for antibiotic usage should be made to lessen the antibiotic restrains pressure; Isolation of source of infection, interruption of routs of transmission and protection of the susceptible patients; strictly the administration about the pneumonia relating the usage of respirator should be made to control the transition of drug resistant bacteria.

关 键 词：重症监护病房 下呼吸道感染 耐药菌 痰培养 

分 类 号：R56[医药卫生—呼吸系统]