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目的了解重症监护病房(ICU)下呼吸道感染病原菌分布及耐药情况,为临床用药提供参考。方法对2007年1月至2008年12月ICU220例下呼吸道感染患者阳性痰培养及药物敏感度结果进行分析。结果220例患者分离出菌株280株。革兰阴性(G-)菌178株,占63.5%,前4位分别为肺炎克雷伯菌(17.1%)、铜绿假单胞菌(13.2%)、鲍曼不动杆菌(12.5%)和嗜麦芽窄食单胞菌(10.4%);革兰阳性(G+)菌70株,占25.1%,耐甲氧西林金黄色葡萄球菌(MRSA)63株;真菌32株,占11.4%,以白色念珠菌为主。对铜绿假单胞菌敏感度在65%以上的有美罗培南、亚胺培南、阿米卡星、头孢哌酮/舒巴坦。肺炎克雷伯菌和鲍曼不动杆菌对美罗培南、亚胺培南具有高敏感度;嗜麦芽窄食单胞菌对左氧氟沙星敏感度较高。MRSA对万古霉素敏感度为100%。结论ICU下呼吸道感染病原菌以G-菌为主,其中肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌和嗜麦芽窄食单胞菌构成主要感染菌株;亚胺培南、美罗培南仍然是控制G-杆菌感染的最有效药物,但应注意到相当数量对亚胺培南、美罗培南耐药菌株的出现;MRSA感染比例有所增高,万古霉素仍是十分有效的选择。
Objective To understand the distribution and drug resistance of pathogenic bacteria in lower respiratory tract infection in intensive care unit (ICU) and provide references for clinical use. Methods From January 2007 to December 2008 ICU 220 cases of lower respiratory tract infection in patients with positive sputum culture and drug susceptibility results were analyzed. Results A total of 280 isolates were isolated from 220 patients. 178 strains of Gram-negative bacteria accounted for 63.5%, the former 4 strains were Klebsiella pneumoniae (17.1%), Pseudomonas aeruginosa (13.2%), Acinetobacter baumannii (12.5%) and 70 strains of Gram-positive bacteria (25.1%), 63 strains of methicillin-resistant Staphylococcus aureus (MRSA), 32 strains of fungi (11.4%) with white Candida-based. Meropenem, imipenem, amikacin, cefoperazone / sulbactam are more than 65% sensitive to Pseudomonas aeruginosa. Klebsiella pneumoniae and Acinetobacter baumannii have high sensitivity to meropenem and imipenem; Stenotrophomonas maltophilia is more sensitive to levofloxacin. MRSA sensitivity to vancomycin is 100%. Conclusions The main pathogens of lower respiratory tract infection in ICU are G-bacteria, of which Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii and Stenotrophomonas maltophilia constitute the major infectious strains; imipenem, ROP is still the most effective drug for controlling G-cell infections, but a significant amount should be noted for the emergence of resistant imipenem and meropenem resistant strains; an increased proportion of MRSA infections and vancomycin remains a very effective option.