ICU病人呼吸道感染常见病原菌的耐药性分析  

Analysis of the drug resistance of common pathogenic bacteria in ICU patients with respiratory tract infection

作　　者：杜红丽[1] 张梅[1] 刘娜[1] 张长庚[1] 

机构地区：[1]衡水哈励逊国际和平医院检验科,河北衡水053000

出　　处：《现代预防医学》2015年第12期2293-2295,共3页Modern Preventive Medicine

摘　　要：目的探讨重症监护病房(ICU)医院呼吸道感染病原菌的分布及耐药情况,为临床治疗提供指导。方法采用法国生物梅里埃公司生产的VITEK-2全自动细菌鉴定及药敏分析仪对我院2012年1月-2013年12月ICU呼吸道感染患者分离出的717株病原菌进行分析及鉴定。结果 717株病原菌中革兰阴性菌665株占92.7%,排在前4位的是鲍曼不动杆菌239株占33.3%,铜绿假单胞菌150株占20.9%,肺炎克雷伯菌101株占14.1%,粘质沙雷菌32株占4.5%;革兰阳性菌42株占5.9%,主要是金黄色葡萄球菌和屎肠球菌;真菌10株占1.4%,均为白色假丝酵母菌。多重耐药菌223株占31.1%。药敏结果显示:鲍曼不动杆菌和铜绿假单胞菌对头孢哌酮/舒巴坦耐药率分别为2.1%和10.0%,亚胺培南耐药率分别为43.1%和38.7%;对氨苄西林/舒巴坦和氨曲南耐药率>70%;肺炎克雷伯菌亚胺培南和阿米卡星耐药率<10%,对头孢曲松、头孢他啶和头孢吡肟耐药率均>75%;金黄色葡萄球菌万古霉素和利奈唑烷100.0%敏感,可作为重症感染时经验用药。结论 ICU患者呼吸道感染病原菌以革兰阴性杆菌为主,对常用抗生素耐药严重,且呈多重耐药。应加强细菌耐药性监测,根据药敏合理用药、减少多重耐药菌产生、降低医院感染率。Objective The objective of the study was to investigate the distribution and drug resistance of pathogenic bacteria in ICU patients with respiratory tract infection, and thus to provide a guideline for clinical treatment of the infections. Methods A total of717 strains of pathogenic bacteria were isolated from ICU patients with respiratory tract infection hospitalized in our hospital between January of 2012 and December of 2013 and were identified and analyzed for drug resistance by VITEK-2（bio Mérieux,France）. Results Among the 717 strains of pathogenic bacteria, 665 strains（92.7%） were gram-negative, with the four most prevalent being Acinetobacter baumannii（239 strains, 33.3%）, Pseudomonas aeruginosa（150 strains, 20.9%）, Klebsiella pneumoniae（101strains, 14.1%）, and Serratia marcescens（32 strains, 4.5%）. 42 strains（5.9%） were gram-positive, and were mainly Staphylococcus aureus and Enterococcus faecium. 10 strains（1.4%） were fungi and were all Saccharomyces albicans. 223 strains（31.1%） were multi-drug resistant. Drug sensitivity results showed that the A. baumannii and P. aeruginosa were 2.1% and 10% resistant against cefoperazone/sulbactam, respectively; 43.1% and 38.7% resistant against imipenem, respectively; and 〉70% resistant against ampicillin/sulbactam and aztreonam. The K. pneumoniae was 〈10.0% resistant against imipenem and amikacin; and 〉75%resistant against ceftriaxone, ceftazidime, and cefepime. The S. aureus were 100% sensitive to vancomycin and linezolid, suggesting that vancomycin and linezolid can be used for empirical treatment of severe infections. Conclusion Gram-negative bacteria are responsible for most respiratory tract infection among ICU patients; the bacteria are widely resistant against common antibiotics and exhibit multi-drug resistance. Monitoring of bacterial resistance should be strengthened and antibiotics should be rationally used according to drug sensitivity results to reduce the emergence of multi-drug resistant bacteria and reduce

关 键 词：ICU 呼吸道感染 医院感染 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]