ICU患者下呼吸道感染病原菌的分布及其耐药性分析  

Distribution and drug resistance of pathogens in patients with lower respiratory tract infection in intensive care unit

作　　者：王万海[1] 徐岷[1] 张傅山[1] 叶亚菲[1] 黄凯达[1] 朱庆华[1] 明亮[1] 

机构地区：[1]郑州大学第一附属医院检验科,郑州市450052

出　　处：《中华实验和临床感染病杂志（电子版）》2013年第3期36-40,共5页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：郑州大学第一附属医院青年创新项目(No.201101);国家自然科学资金资助项目(U1204811)

摘　　要：目的探讨重症监护病房(ICU)患者下呼吸道感染病原菌的分布特点及耐药情况,为其治疗提供依据。方法对2012年1月至5月于本院ICU住院的患者所送检的痰标本进行细菌培养、鉴定和药敏试验。结果 239例合格痰标本中79例为菌群正常,其余160例共检出177株病原菌,以革兰阴性杆菌为主,占76.8%(136/177),革兰阳性球菌占15.3%(27/177),真菌占7.9%(14/177)。在细菌中鲍曼不动杆菌居第一位(32.5%,53/163),其次为铜绿假单胞菌(23.3%,38/163)、金黄色葡萄球菌(16.6%,27/163)和肺炎克雷伯菌(9.2%,15/163),以上细菌占所分离菌株的81.6%(133/163)。11.0%(16/146)患者出现多重感染,并以金黄色葡萄球菌和革兰阴性杆菌的混合感染为主,占56.2%(9/16)。药敏试验结果显示,鲍曼不动杆菌对17种抗菌药物中16种的耐药率均>68%,而铜绿假单胞菌对17种抗菌药物中14种的耐药率均>55%;肺炎克雷伯菌和大肠埃希菌对16种抗菌药物的耐药率>60%者分别达14种和13种;金黄色葡萄球菌对12种抗菌药物中10种的耐药率均>74%。结论 ICU患者下呼吸道感染的病原菌以革兰阴性杆菌为主,且鲍曼不动杆菌为首位感染病原菌;病原菌显示多重耐药,鲍曼不动杆菌仅对米诺环素敏感性较好,铜绿假单胞菌和肠杆菌科细菌仅对亚胺培南敏感性较好,而金黄色葡萄球菌仅对万古霉素敏感。需加强ICU病原菌及耐药性监测,为临床合理使用抗菌药物提供参考依据。Objective To investigate the distribution and antibiotic resistance of pathogens among patients with lower respiratory tract infection in intensive care unit （ICU）. Methods The bacterial spectrum and drug resistance of 239 patients with lower respiratory tract infection in ICU from January to May 2012 were analyzed, retrospectively. Results Total of 177 pathogens were identified from the sputum in 160 patients, including the gram-negative bacteria （76.8%, 136/177）, the gram-positive bacteria （15.3%, 27/177） and the fungus （7.9%, 14/177）. The most common pathogens in low respiratory tract were Acinetobacter baumannii （32.5%, 53/163）, Pseudomonas aeruginosa （23.3%, 38/163）, Staphylococcus aureus （16.6%, 27/163） and Klebsiella pneumoniae （9.2%, 15/163）. Sixteen patients were multiple infection （11.0%, 16/146） and most of them （56.2%, 9/16） were Staphylococcus aureus and the gram-negative bacteria co-infection. Among the 17 kinds of antibiotics applied, the resistance rates ofAcinetobacter baumannii to16 kinds of antibiotics and Pseudomonas aeruginosa to 14 kinds of antibiotics were higher than 68% and 55%, respectively. Among the 16 kinds of antibiotics applied, Klebsiella pneumoniae and Escherichia colihad higher than 60% resistance rates to 14 and 13 kinds of antibiotics, respectively. Among the 12 kinds of antibiotics used, Staphylococcus aureus had higher than 74% resistance rate. Conclusions The gram-negative bacteria were the major pathogens and Acinetobacter baumannii ranked the first. Gram-negative bacilli and gram-positive cocci showed wide resistance to drugs, the Acinetobacter baumannii were only sensitive to minocycline, the pseudomonas aeruginosa and enterobacteriaceae were only sensitive to imipenem, and Staphylococcus aureus were only sensitive to vancomycin. The monitoring of drug-resistance of pathogenic bacteria should be strengthened in ICU, which could provide proof to antibiotics application for clinical rational.

关 键 词：重症监护病房 院内感染 病原菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学]