ICU下呼吸道医院感染病原菌分布及耐药性分析  

Distribution and drug resistance of pathogens causing lower respiratory tract infections in ICU

作　　者：叶帮芬[1] 袁翊[1] 

机构地区：[1]内江市第一人民医院检验科,四川内江641000

出　　处：《中华医院感染学杂志》2012年第18期4160-4162,共3页Chinese Journal of Nosocomiology

摘　　要：目的了解医院ICU患者的下呼吸道医院感染病原菌特征并进行耐药性分析,为临床用药提供依据。方法对2010年1月-2011年7月ICU 951例医院感染患者,痰标本的细菌学培养结果进行回顾性分析。结果ICU下呼吸道医院感染的病原菌以革兰阴性杆菌为主,占79.0%,主要有鲍氏不动杆菌225株、铜绿假单胞菌151株、肺炎克雷伯菌102株、大肠埃希菌43株、阴沟肠杆菌31株、嗜麦芽寡养单胞菌27株;革兰阳性球菌占17.7%,主要有金黄色葡萄球菌91株,其中MRSA 86株占94.5%,凝固酶阴性葡萄球菌30株,其中MRSCN 26株占86.7%,真菌占3.3%;革兰阴性杆菌对常用抗菌药物耐药率高,对亚胺培南、美罗培南耐药率相对较低,革兰阳性球菌对万古霉素、替考拉宁均敏感。结论 ICU下呼吸道医院感染以革兰阴性杆菌为主,显示多药耐药性,且耐药现象严重,应严格控制并谨慎使用新的超广谱β-内酰胺类抗菌药物,加强医院感染的预防和控制。OBJECTIVE To find out the characteristics of pathogenic bacteria isolated from sputum of patients with lower respiratory tract infections in ICU, to analyze their drug resistance so as to foundation for clinical medication. METHODS We analyzed retrospectively the results of bacterial cultures of sputum specimens isolated from 951 patients with lower respiratory tract infection in general ICU from Jan 2010 to Jul 2011. RESULTS In the 951 sputum specimens, the most common bacteria isolated were gram-negative bacilli （79. 0%）, followed by gram-positive cocci（17.7%） and fungi（3.3%）. The amount of isolated gram-negative bacterial strain of Acineto- bacter baurnannii , Pseudomonas aeruginosa , Klebsiella pneumoniae , Escherichia coli , Enterobacter cloacae and Stenotrophomonas maltophilia were 225 strains, 151 strains, 102 strains, 43 strains, 31 strains and 27 strains, respectively. The leading gram-positive cocci were S. aureus（91 strains）and coagulase negative Staphylococcus（30 strains）, among which MRSA（86 strains） and MRSCN（26 strains） occupied 94.5% and 86.7%, respectively; the drug resistance rates of gram-negative bacilli to common antibiotics were high, the resistance rates to imipenem and meropenem were relatively low, and gram-positive cocci were susceptible to vancomycin and teicoplanin. CONCLUSION The main pathogenic bacteria isolated from sputum of patients with lower respiratory tract hospital infection in general ICU are gram-negative bacilli, and they are highly multidrug-resistant. The new extended- spectrum beta-lactam antibiotics should be controlled strictly and used cautiously so as to strengthen the prevention and control of hospital infections.

关 键 词：重症监护病房 医院感染 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]