ICU患者肺部感染的病原菌分布及耐药性分析  

Distribution and drug resistance of pathogens causing pulmonary infections in ICU patients

作　　者：来孺牛[1] 王亚南[1] 金国萍[2] 周建明[3] 

机构地区：[1]绍兴市人民医院浙江大学绍兴医院呼吸内科,浙江绍兴312000 [2]绍兴市人民医院浙江大学绍兴医院重症监护室,浙江绍兴312000 [3]浙江大学公共卫生学院预防医学系,浙江杭州310000

出　　处：《中华医院感染学杂志》2014年第1期53-55,共3页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技计划基金项目(2009FWG075)

摘　　要：目的分析ICU医院肺部感染的病原菌分布及耐药性,为防治感染提供客观依据。方法回顾性分析2010年1月-2012年12月ICU转回呼吸内科56例肺部感染患者分离到的病原菌分布及耐药性,采用法国生物梅里埃公司VITEK-32型全自动微生物分析仪及配套的GNI+鉴定卡对痰液标本进行菌株鉴定,药敏试验采用K-B纸片扩散法,结果判定依据NCCLS颁布的标准。结果 56例肺部感染患者痰液标本中共分离出病原菌118株,其中革兰阴性菌89株占75.42%,革兰阳性菌17株占14.41%,真菌12株占10.17%;铜绿假单胞菌、鲍氏不动杆菌、嗜麦芽寡养单胞菌3种主要革兰阴性菌均对头孢哌酮/舒巴坦耐药率分别为27.27%、24.24%、30.78%;17株革兰阳性菌中检出16株耐甲氧西林葡萄球菌,检出率94.11%,其中耐甲氧西林金黄色葡萄球菌13株,耐甲氧西林表皮葡萄球菌3株,未发现对万古霉素及替考拉宁的耐药菌株。结论 ICU医院肺部感染为多重菌株混合感染,主要为革兰阴性菌,分离菌易呈现多药耐药性,治疗难度大;应加强ICU医院肺部感染的预防,并依据药敏试验结果合理选择抗菌药物对患者进行治疗。OBJECTIVE To analyze the distribution and drug resistance of pathogens causing pulmonary infections in ICU patients so as to provide objective basis for prevention of the infections.METHODS Totally 56cases of pulmonary infections,who were transferred from the ICU to respiratory medicine department between Jan 2010and Dec 2012,were enrolled in the study,then the distribution and drug resistance of pathogens isolated from the subjects were retrospectively analyzed;the identification of the strains isolated from sputum specimens was performed with the use of VITEK-32automatic microorganisms analyzer combined with matching GNI＋identification card,the drug susceptibility testing was performed by using K-B disc diffusion method,and the result was determined by referring to the standards issued by the NCCLS.RESULTS A total of 118strains of pathogens have been isolated from the sputum specimens obtained from the 56cases of pulmonary infections,including 89（75.42%）strains of gram-negative bacteria,17（14.41%）strains of gram-positive bacteria,and 12（10.17%）strains of fungi.Among the gram-negative bacteria isolated,the drug resistance rate of the Pseudomonas aeruginosa to cefoperazone-sulbactam was 27.27%,the Acinetobacter baumannii 24.24%,the Stenotrophomonas maltophilia 30.78%.Totally 16strains of methicillin-resistant Staphylococcus have been detected from the 17strains of gram-positive bacteria with the detection rate of 94.11%,including 13strains of methicillin-resistant Staphylococcus aureus and 3strains of methicillin-resistant Staphylococcus epidermidis;while the strains resistant to vancomycin or teicoplanin have not been detected.CONCLUSION Most of the cases of pulmonary infections are the mixed infections caused by multiple species of pathogens which are dominated by the gram-negative bacteria;the isolated pathogens show multidrug-resistant,which brings difficulty to the treatment;it is necessary to strengthen the prevention of pulmonary infections in the ICU and reasonably use antibiotics based on t

关 键 词：重症监护病房 肺部感染 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]