摘要
目的监测下呼吸道感染患者病原菌的分布和耐药谱,指导临床合理应用抗菌药物。方法对2008年全年及2009年1-3月桂林医学院附属医院重症监护病房（ICU）下呼吸道感染患者病原菌的菌群分布、耐药性进行分析。结果革兰阴性杆菌是引发呼吸道感染的主要病原菌,占87.3%,其中以铜绿假单胞菌、鲍氏不动杆菌占优势,分别占44.7%、22.5%。在31株革兰阳性球菌中,金黄色葡萄球菌为主要菌群,占革兰阳性球菌54.8%。在73株真菌中以白假丝酵母菌为主,占真菌的68.5%。铜绿假单胞菌对亚胺培南、美罗培南、多黏菌素E、环丙沙星、阿米卡星、妥布霉素、庆大霉素的耐药率分别为11.8%-27.2%,对青霉素类、头孢菌素类及含β-内酰胺酶抑制剂复合剂等其他抗菌药物的耐药率则为38.2%-100.0%;鲍氏不动杆菌对亚胺培南、美罗培南的耐药率分别为7.9%、8.8%,而对其他抗菌药物的耐药率较高,分别为53.5%-100.0%;大肠埃希菌产ESBLs率（90.9%）高于肺炎克雷伯菌的产酶率（36%）,均对美罗培南、亚胺培南敏感,对于其他的抗菌药物,大肠埃希菌的耐药性普遍较肺炎克雷伯菌严重,MRSA占所分离金黄色葡萄球菌的52.9%。结论该院ICU下呼吸道感染病原菌以革兰阴性杆菌为主,其对常用抗菌药物耐药性较高,应加强监测与控制。
Objective To monitor the distribution and drug resistance of pathogentic bacteria isolated from the patients with lower respiratory tract infection,and to guide rational use of antibiotics in clinic.Methods The distribution and drug-resistance profile of pathogentic bacteria isolated from lower respiratory tract infection patients admitted to the ICU of Affiliated Hospital of Guilin Medical College from January,2008 to March,2009 were analyzed.Results 87.3% of pathogenic bacteria were Gram-negative bacteria,among them,Pseudomonas aeruginosa and Acinetobacter baumannii predominated in number（44.7% and 22.5%）.Staphylococcus aureus（54.8%） was the most prominent in 31 strains of Gram-positive bacteria.Candida albicans（68.5%） was the most prominent in 73 strains of fungi.Of P.aeruginosa strains,the antibiotic resistant rates to imipenem,meropenem,polymyxicn E,ciprofloxacin,amikacin,tobramycin and gentamicin were 11.8% ～27.2%,respectively;while the resistant rates to the other antibiotics（including penicillins,cephalosporins and the complex antibiotics containing β-lactamases inhibitor） were 38.2%～100.0%,respectively.Of A.baumannii strains,the antibiotic resistant rates to imipenem and meropenem were 7.9% and 8.8%,respectively;while the resistant rates to the other antibiotics were higher（53.5%～100.0%,respectively）.The ESBLs-producing rate of E.coli strains （90.9%） was higher than that of K.pneumoniae strains（36%）.K.pneumoniae strains and E.Coli strains were all sensitive to meropenem and imipenem,but the resistance of E.coli strains against the other antibiotics was more serious than that of K.pneumoniae strains.Methicillin-resistant Staphylococcus aureus（MRSA） was about 52.9%.Conclusions Gram-negative bacilli are the main pathogens of lower respiratory tract infection among the patients in ICU,and their antibiotic resistance rates continue to increase.The hospital should strengthen monitoring and controlling of them.
出处
《实用预防医学》
CAS
2010年第10期1932-1935,共4页
Practical Preventive Medicine
关键词
重症监护病房
下呼吸道感染
病原菌
耐药性
Intensive care unit
Lower respiratory tract infection
Pathogen
Drug resistance
