危重患者下呼吸道病原菌分布及耐药性分析

目的探讨危重病患者下呼吸道感染的病原菌分布及非发酵菌对抗菌药物的耐药率,以指导临床抗菌药物的合理使用。方法回顾性分析绍兴市人民医院349例危重病患者分离的病原菌及非发酵菌的耐药性。结果445株病原菌中,革兰阴性菌343株,占77.1%,革兰阳性菌40株,占9.0%,真菌62株,占13.9%;最常见病原菌分别为鲍氏不动杆菌129株,占28.9%,铜绿假单胞菌56株,占12.6%,白色假丝酵母菌54株,占12.1%,洋葱伯克霍尔德菌42株,占9.4%,嗜麦芽寡养单胞菌39株,占8.8%;在几种主要非发酵菌中,鲍氏不动杆菌对亚胺培南、美罗培南、左氧氟沙星及含酶抑制剂的抗菌药物敏感;铜绿假单胞菌对阿米卡星、环丙沙星和头孢哌酮/舒巴坦等敏感性较高;洋葱伯克霍尔德菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦敏感性较高,嗜麦芽寡养单胞菌仅对磺胺甲噁唑/甲氧苄啶较为敏感。结论非发酵菌为危重患者下呼吸道感染的重要致病菌,抗菌治疗应以病原学及耐药性监测结果为依据。

Distribution and drug resistance of pathogens from lower respiratory tract of critically ill patients

OBJECTIVE To probe the distribution of the pathogens causing lower respiratory tract infections and drug resistance of non-fermenting bacteria isolated from critically ill patients,so as to provide basis for clinical reasonable use of antibiotics.METHODS The drug resistance of the pathogens and non-fermenting bacteria isolated from 349 critically ill patients in Shaoxing People’s Hospital was retrospectively analyzed.RESULTS Of 445 strains of pathogens,there were 343(77.1%) strains of gram-negative bacteria,40(9.0%)strains of gram-positive bacteria,and 62(13.9%) strains of fungi;the most common pathogens were Acinetobacter baumannii(129 strains,28.9%),Pseudomonas aeruginosa(56 strains,12.6%),Candida albicans(54 strains,12.1%),Burkholderia cepacia(42 strains,9.4%),and Stenotropomonas maltophilia(39 strains,8.8%);among the major species of non-fermenting bacteria,A.baumannii was susceptible to imipenem,meropenem,levofloxacin,and antimicrobial agents with β-lactamas inhibitors;P.aeruginosa was susceptible to amikacin,ciprofloxacin,and cefoperazone/sulbactam.B.cepacia was susceptible to piperacillin/tazobactam and cefoperazone/sulbactam,S.maltophilia was only susceptible to sulfamethoxazole/trimethoprim.CONCLUSION Non-fermenting bacteria are the major pathogens causing lower respiratory tract infections in critically ill patients,it is suggested that the adequate antimicrobial treatment should be based on the surveillance of etiology and drug resistance.