EICU重症肺炎患者病原学与耐药性分析  

Distribution and drug resistance of pathogens isolated from patients with severe pneumonia in EICU

作　　者：王文欣[1] 周茄 张宇[1] 尚跃丰[1] 

机构地区：[1]天津医院急诊科,天津300192 [2]天津医院普内科,天津300192

出　　处：《中华医院感染学杂志》2017年第17期3845-3847,3859,共4页Chinese Journal of Nosocomiology

摘　　要：目的了解医院急诊监护病房(EICU)重症肺炎患者感染病原菌分布及耐药性,为合理使用抗菌药物提供依据。方法选取2016年3月-2017年4月医院EICU 67例重症肺炎患者为研究对象,对感染患者的病原菌分布及耐药性进行分析。结果 EICU重症肺炎患者送检标本中,共检出病原菌129株,其中革兰阴性菌83株占64.34%,以铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌为主,革兰阳性菌27株占20.93%,以金黄色葡萄球菌、肺炎链球菌、溶血性葡萄球菌为主,真菌19株占14.73%;铜绿假单胞菌对替加环素和美罗培南均100.00%敏感,但对氨曲南和替卡西林/克拉维酸耐药性较高,分别为32.35%和35.29%;肺炎克雷伯菌对阿米卡星与替加环素100.00%敏感,对替卡西林/克拉维酸、头孢他啶等耐药率较高,分别为45.45%、36.36%;鲍氏不动杆菌对美罗培南、亚胺培南100.00%敏感,对氨曲南、左氧氟沙星耐药率较高,分别为44.44%、44.44%;金黄色葡萄球菌对美罗培南、万古霉素较敏感,对青霉素耐药率高达90.91%;肺炎链球菌对替加环素、万古霉素较敏感,对青霉素、庆大霉素耐药性较高,分别为55.56%、44.44%。结论医院EICU重症肺炎患者感染病原菌主要以革兰阴性菌为主,细菌耐药性较为严重,应提高标本送检率,根据药敏试验结果合理选择抗菌药物,同时注重监测耐药菌情况。OBJECTIVE To investigate the distribution and drug resistance of pathogens isolated from patients with severe pneumonia in emergency intensive care unit（EICU）so as to provide guidance for reasonable use of antibiotics.METHODS A total of 67 patients with severe pneumonia who were treated in EICU of the hospital from Mar 2016 to Apr 2017 were recruited as the study objects.The distribution and drug resistance of the pathogens were observed.RESULTS Totally 129 strains of pathogens were isolated from submitted specimens of the EICU patients with severe pneumonia,of which 83（64.34%）were gram-negative bacteria,27（20.93%）were gram-positive bacteria,and 19（14.73%）were fungi;Pseudomonas aeruginosa,Klebsiella pneumoniae and Acinetobacter baumannii were dominant among the gram-negative bacteria;Staphylococcus aureus,Streptococcus pneumoniae and Staphylococcus haemolyticus were the predominant species of the gram-positive bacteria.The drug susceptibility rates of the P.aeruginosa strains to tigecycline and meropenem were 100.00%,however,the drug resistance rates to aztreonam and ticarcillin-clavulanic acid were 32.35%and 35.29%,respectively.The drug susceptibility rates of the K.pneumoniae strains to amikacin and tigecycline were 100.00%,and the drug resistance rates to ticarcillin-clavulanic acid and ceftazidime were 45.45%and 36.36%,respectively.The drug susceptibility rates of the A.baumannii strains to meropenem and imipenem were 100.00%,and the drug resistance rates to aztreonam and levofloxacin were 44.44%and 44.44%,respectively.The S.aureus strains were highly susceptible to meropenem and vancomycin,and the drug resistance rate to penicillin was as high as 90.91%.The S.pneumoniae strains were highly susceptible to tigecycline and vancomycin,and the drug resistance rates to penicillin and gentamicin were 55.56%and 44.44%,respectively.CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the EICU patients with severe pneumonia and are highly drug-resistant.It is necessary t

关 键 词：EICU 重症肺炎 医院感染 病原菌 耐药性分析 

分 类 号：R378[医药卫生—病原生物学]