重症监护病房内嗜麦芽窄食单胞菌医院感染肺炎的临床及耐药性研究

Objective To investigate the clinical characteristics and resistance of Stenotrophomona maltophila in intensive care unit.Methods 47 cases with nosocomial pneumonia by Stenotrophomona maltophila in intensive care unit from Jan 2003 to Nov 2007 were studied retrospectively.Results All patients had clinical symptoms,treatment with broad spectrum of antibiotics,the length of stay in ICU,artificial airways,mechanical ventilation,central venous catheter and usage of immunosuppressor,all the factor were obviously related with Stenotrophomona maltophila;SMITMP,ticarcillin/clavulanate,cefoperazone/sulbactam,levo-floxacin,ciprofloxacin were higher susceptive to S: maltophila,in range of 80.85%～61.7%.Conclusion The drug resistance in this kind of bacterium is extremely severe,and it mainly cause the infection of respiratory tract.Decreasing days being in hospital and ICU,using antibiotic reasonably,reducing invasive operation may decrease the infection of S.maltophila.     

重症监护病房内嗜麦芽窄食单胞菌医院感染肺炎的临床及耐药性研究

Objective To investigate the clinical characteristics and resistance of Stenotrophomona maltophila in intensive care unit.Methods 47 cases with nosocomial pneumonia by Stenotrophomona maltophila in intensive care unit from Jan 2003 to Nov 2007 were studied retrospectively.Results All patients had clinical symptoms,treatment with broad spectrum of antibiotics,the length of stay in ICU,artificial airways,mechanical ventilation,central venous catheter and usage of immunosuppressor,all the factor were obviously related with Stenotrophomona maltophila;SMITMP,ticarcillin/clavulanate,cefoperazone/sulbactam,levo-floxacin,ciprofloxacin were higher susceptive to S: maltophila,in range of 80.85%～61.7%.Conclusion The drug resistance in this kind of bacterium is extremely severe,and it mainly cause the infection of respiratory tract.Decreasing days being in hospital and ICU,using antibiotic reasonably,reducing invasive operation may decrease the infection of S.maltophila.     

儿童重症监护病房呼吸机相关性肺炎病原菌分布及耐药性分析

目的 分析儿童重症监护病房(PICU)呼吸机相关性肺炎(VAP)病原菌及耐药情况,为临床合理选用抗菌药物提供依据.方法 回顾性分析2008年1月至2010年6月武汉市儿童医院PICU收治的46例合并VAP患儿下呼吸道分泌物所分离出的细菌、真菌及其耐药性情况.结果 共分离出病原菌119株,革兰氏阴性(G-)杆菌、革兰氏阳性(G+)球菌和真菌分别占65.55%、13.45%和21.01%;前5位病原菌分别为鲍氏不动杆菌、大肠埃希氏菌、肺炎克雷伯氏菌、白色念珠菌及凝固酶阴性葡萄球菌.药敏结果显示,G-杆菌和G+球菌对临床常用抗菌药物均存在不同程度耐药性,多重耐药现象严重.G-杆菌对阿米卡星、环丙沙星、亚胺培南、美罗培南、头孢哌酮/舒巴坦、派拉西林/他唑巴坦较为敏感;G+球菌均对万古霉素、替考拉宁和利奈唑胺敏感;真菌普遍敏感.结论 VAP病原菌以G-杆菌为主且呈多重耐药性.临床上应对VAP进行规范性、连续性耐药性监测,并依据细菌病原学及耐药性合理选择抗菌药物,同时加强机械通气管理以及医院环境消毒,降低VAP发生率.

Abstract：

Objective To study the pathogenic bacteria strains with drug-resistance prevailing in patients with ventilator-associated pneumonia(VAP)in Pediatric Intensive Care Unit(PICU)in order to provide a reasonable guidance to the clinical use of suitable antibiotics.Method A retrospective clinical study in 46 patients with VAP was carried out in PICU of Wuhan Children's Hospital between January 2008 and June 2010.The prevalent strains of the pathogenic bacteria with drug-resistance isolated from lower respiratory tract by aspiration were analyzed.Results In total,119 pathogenic microbial strains were isolated including Gram-negative bacilli(G-,65.55%),fungi(21.01%)and Gram-positive cocci(G+,13.45%).Among pathogens,the most common pathogenic strains were Acinetobacter baummannii, Escherichia coli,Klebsiella pneumoniae,candida albicans and coagulase-negative staphylococci.Antibiotic susceptibility tests indicated that the situation of the multiple drug-resistances to antibiotics found in G- and G+ Was serious. Most of G- were sensitive to ciprofloxacin, amikacin, imipenem, meropenem,cefoperazone-sulbaetam and piperacillin-tazobactam.The G+ cocci were 100% susceptibility to vancomycin, teicoplanin and linezolid.Fungi were almost sensitive to all the anti-funaus agents. Conclusions The oredominant oathogens of VAP were G- bacilli,and their multiple drug-resistances to antibiotics were the serious problems.The monitoring of the drugresistance should be emphasized, and the option of antibiotics should depend on the antibiotic sensitivity test.     

重症监护病房下呼吸道感染临床特点及病原菌耐药性分析

目的 了解重症监护病房(ICU)患者下呼吸道感染的临床特点和病原菌分布及耐药情况,为临床合理使用抗菌药物提供依据.方法 对2008年1月至2010年8月我院ICU发生下呼吸道感染患者的临床资料进行回顾性分析,对分离出的病原菌进行菌株鉴定,药敏试验采用琼脂扩散(K-B)法,结果依据CLSI(2007)标准判读.结果 ICU共收治患者509例,发生下呼吸道感染147例,下呼吸道感染发生率为28.9%(147/509);分离出病原菌283株,其中主要为G-杆菌占86.9%,其他病原菌包括G+球菌(7.4)%和真菌(5.7)%;最常见的病原菌依次为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、嗜麦芽寡养单胞菌、真菌、大肠埃希菌、金黄色葡萄球菌、洋葱伯克霍尔德菌等,分别占24.7%、20.5%、12.7%、6.4%、5.7%、5.3%、5.3%、4.6%;主要病原菌对多种抗菌药物耐药严重.结论 ICU下呼吸道感染的发生率高,G-杆菌是导致下呼吸道感染的主要病原菌,且对抗菌药物呈多重耐药.     

女性泌尿生殖道支原体感染及耐药性分析

Objective To analyze the infection and drug resistance of Ureaplasma urealyticum (Uu) and mycoplasma hominis ( Mh) among female urogenital tract in 2008,hope to provide the data of epidemiology and guide of antibiotics use.Methods Cervical secretion was identified and their antibiotic susceptibility was detected with Mycoplasma IST 2 Reagent from France,the result of mycoplasma cultivation and the sensitivities to antibiotics was analyzed.Results The positive rate of Mycoplasma was 58.6%(610/1 041),among the the 610 positive sample,519(49.9%) cases were Uu positive; 10 cases(1%)were Mh positive;81 ca-ses(7.8%)vrere both Uu and Mh positive;the susceptibility to all these 9 antimicrobial agents in sequence wase Pristinamycin(99.8%)、 Josamycin(99.5%),Doxycycline(96.1 % )、Tetracycline(93.4%) 、Clarithromycin(83.8%)、 Azithromycin(75.9%)、Erythro-mycin(73.4%)、Ofloxacin(27.9%) and Ciprofloxacin(21.8%).Conclusion Mycoplasma (especially Uu) was the main pathogen of urogenital tracts among female with great variation of susceptibility to antibiotics.The sensitive antibiotics should be used to treat the infection of Uu and Mh,such as Pristinamycin,Josamycin,Doxycycline.But Mycoplasma have a high resistance rate to quinolones,that should be paid more attention.     

女性泌尿生殖道支原体感染及耐药性分析

Objective To analyze the infection and drug resistance of Ureaplasma urealyticum (Uu) and mycoplasma hominis ( Mh) among female urogenital tract in 2008,hope to provide the data of epidemiology and guide of antibiotics use.Methods Cervical secretion was identified and their antibiotic susceptibility was detected with Mycoplasma IST 2 Reagent from France,the result of mycoplasma cultivation and the sensitivities to antibiotics was analyzed.Results The positive rate of Mycoplasma was 58.6%(610/1 041),among the the 610 positive sample,519(49.9%) cases were Uu positive; 10 cases(1%)were Mh positive;81 ca-ses(7.8%)vrere both Uu and Mh positive;the susceptibility to all these 9 antimicrobial agents in sequence wase Pristinamycin(99.8%)、 Josamycin(99.5%),Doxycycline(96.1 % )、Tetracycline(93.4%) 、Clarithromycin(83.8%)、 Azithromycin(75.9%)、Erythro-mycin(73.4%)、Ofloxacin(27.9%) and Ciprofloxacin(21.8%).Conclusion Mycoplasma (especially Uu) was the main pathogen of urogenital tracts among female with great variation of susceptibility to antibiotics.The sensitive antibiotics should be used to treat the infection of Uu and Mh,such as Pristinamycin,Josamycin,Doxycycline.But Mycoplasma have a high resistance rate to quinolones,that should be paid more attention.     

老年女性糖尿病患者尿路感染病原菌的体外耐药性监测

目的 探讨老年女性糖尿病患者尿路感染病原菌的分布情况及耐药特征,为临床合理使用抗菌素提供依据.方法 收集老年女性糖尿病患者尿路感染病原菌107株,采用法国梅里埃公司VITEK32分析仪进行细菌鉴定和体外药敏试验.结果 107株病原菌中,革兰阴性杆菌感染占74.8%(80/107),以大肠埃希菌为主,占48.6(52/107);革兰阳性球菌占13.1%(14/107);真菌占12.1%(13/107).革兰阴性杆菌对氨苄西林、头孢唑啉、头孢呋辛钠、头孢呋辛酯耐药率均高于70.0%,对亚胺培南、丁胺卡那霉素耐药率均低于10.0%.革兰阳性球菌对万古霉素、利奈唑烷耐药率分别为0和7.1%(1/14).结论 老年女性糖尿病患者尿路感染主要病原菌是大肠埃希菌,该菌耐药性较强,临床上应加强糖尿病患者尿路感染病原菌的检测和耐药性监测.

Abstract：

Objective To determine the distribution and antibiotics resistance characteristic of pathogens in urinary tract infections in aged female diabetics patients and provide scientific basis for clinicians in selecting effective antibiotics. Methods Pathogenic bacteria, isolated from specimens of 107 elderly female diabetic cases with urinary tract infections, were identified and drug susceptibility tests were performed by VITEK-32 analysator. Results Among all 107 kinds of isolated bacteria,the ratio of gram-negative bacteria was 74. 8% ( 80/107 ), predominated by Escherichiacoli ( accounting for 48. 6% [52/107] ); the ratio of gramposition bacterias was 13. 1% (14/107) and eumycetes was 12. 1% (13/107). In antibiotic resistance analysis,the gram negative bacteria showed higher drug-resistance to the some common-antibiotics, such as ampicililin,cefazolin,cefuroxime-sodium and cefuroxime axetil ( ＞ 70. 0% ), while they were sensitive to imipenem and amikacin( ＜ 10. 0% ). The gram positive bacteria were most sensitive to vancomycin (0%), followed by Linezolid(7.7% ). Conclusion Escherichiacoli were the major pathogenic bacteria in urinary tract infections in aged female diabetic patients, with higher drug resistance. Therefore, drug resistance monitoring should be carried out according to the variety of pathogenic bacteria so as to guide rational use of antibiotics and decrease drug resistance.     

Outcomes of critically ill cancer patients with Acinetobacter baumannii infection

AIM: To describe the intensive care unit(ICU) outcomes of critically ill cancer patients with Acinetobacter baumannii(AB) infection.METHODS: This was an observational study that included 23 consecutive cancer patients who acquired AB infections during their stay at ICU of the National Cancer Institute of Mexico(INCan), located in Mexico City. Data collection took place between January 2011, and December 2012. Patients who had AB infections before ICU admission, and infections that occurred during the first 2 d of ICU stay were excluded. Data were obtained by reviewing the electronic health record of each patient. This investigation was approved by the Scientific and Ethics Committees at INCan. Because of its observational nature, informed consent of the patients was not required.RESULTS: Throughout the study period, a total of 494 critically ill patients with cancer were admitted to the ICU of the INCan, 23(4.6%) of whom developed AB infections. Sixteen(60.9%) of these patients had hematologic malignancies. Most frequent reasons for ICU admission were severe sepsis or septic shock(56.2%) and postoperative care(21.7%). The respiratory tract was the most frequent site of AB infection(91.3%). The most common organ dysfunction observed in our group of patients were the respiratory(100%), cardiovascular(100%), hepatic(73.9%) and renal dysfunction(65.2%). The ICU mortality of patients with 3 or less organ system dysfunctions was 11.7%(2/17) compared with 66.6%(4/6) for the group of patients with 4 or more organ system dysfunctions(P = 0.021). Multivariate analysis identified blood lactate levels(BLL) as the only variable independently associated with inICU death(OR = 2.59, 95%CI: 1.04-6.43, P = 0.040). ICU and hospital mortality rates were 26.1% and 43.5%, respectively.CONCLUSION: The mortality rate in critically ill patients with both HM, and AB infections who are admitted to the ICU is high. The variable most associated with increased mortality was a BLL ≥ 2.6 mmol/L in the first day of stay in the ICU.     

创伤患者住ICU期间发生院内感染的危险因素分析

目的 探讨导致创伤患者在重症监护病房期间发生院内感染的危险因素.方法 回顾性分析了2009年1月1日至12月31日浙江省5家医院1103名创伤患者的相关资料,通过对16项可能和发生感染的相关因素的单因素以及多因素分析,最终筛选出导致所有创伤患者以及严重创伤患者住ICU期间发生感染的独立危险因素.结果 住ICU期间共有171人(15.5%)发生感染.患者总共死亡157人(14.2%),其中感染组死亡59人.感染组病死率为34.7%,显著高于非感染组的10.5%.多因素logistic回归分析结果提示,对于所有患者而言,中心静脉压监测、机械通气、年龄≥65岁、住ICU时间>14 d以及ISS≥16分为住ICU期间发生院内感染的独立危险因素.对于严重创伤患者,中心静脉压监测、机械通气以及住ICU时间>14 d则是其独立危险因素.结论 伤情严重程度、年龄、住ICU时间以及ICU内侵入性操作与创伤患者住ICU期间发生院内感染相关,规范各种侵入性操作以及尽量减少患者住ICU时间有助于降低患者发生院内感染的机率.

Abstract：

Objective To determine risk factors in nosocomial infection of trauma patients during intensive care unit stay. Methods A retrospective study was carried out. A total of 1103 trauma patients admitted to the intensive care unit of five tertiary hospitals in Zhejiang Province in 2009 were reviewed. Demographic data, injury severity score and other variables related to the trauma services were collected. Univariate and multivariate analysis were processed to identify the independent risk factors of nosocomial infection in trauma patients during stay in intensive care unit. Results Overall, 171 patients( 15.5% )developed nosocomial infection during ICU stay. Of 1103 patients, 157 patients (14.2% ) died, and the 59 fatal patients were from infection group. The mortality rate in infection group was 34.7% , which was significantly higher than that in non - infection group (10.5% ). The independent risk factors of nosocomial infection in all the patients determined by using multivariate analysis included central venous monitoring, mechanical ventilation, age ≥65, the length of ICU stay > 14 days and injury severity score ≥ 16. For the severe trauma patients, central venous monitoring, mechanical ventilation, the length of ICU stay > 14 days were independent risk factors of nonsocomial infection. Conclusions The severity of injury, age, the length of ICU stay and invasive procedures were related to the nosocomial infection. To standardize the invasive procedures and to reduce the length of ICU stay may decrease the infection rate of trauma patients.     

南京地区急性呼吸道感染患儿人博卡病毒的检出与分析

目的 了解南京地区急性呼吸道感染患儿HBoV的检出情况,并探讨HBoV与临床特征的关系.方法 收集2009年7月至2010年6月南京医科大学附属南京儿童医院呼吸科收治的397例急性呼吸道感染住院患儿为病例组,对照组为50例无呼吸道感染症状的儿童.应用实时荧光定量PCR法检测鼻咽分泌物标本HBoV.对HBoV阳性标本,应用实时荧光定量PCR法检测MP和CT,直接免疫荧光法检测RSV、ADV、IVA、IVB、PIV-1、PIV-2、PIV-3和hMPV.随机选取5份HBoV阳性标本扩增HBoV NP-1片段后进行核苷酸序列测定,结果与GenBank中已知序列进行比对,绘制系统进化树.结合HBoV阳性患儿临床资料,分析HBoV的流行病学特点、临床表现和最终临床诊断.结果 实时荧光定量PCR法检出HBoV DNA阳性率为8.3%(33/397),其中有57.6%(19/33)混合其他病原体感染.与HBoV混合感染的前3位病原体依次为MP(27.3%,9/33)、RSV(24.2%,8/33)和PIV.3(12.1%,4/33).7～36个月龄感染HBoV患儿有25例,占HBoV DNA阳性患儿的75.8%(25/33).5份标本HBoV NP-1基因序列均一致,与st1、st2和WHL-1等序列同源性为99%～100%.结论 HBoV是南京地区急性呼吸道感染患儿的病原之一.HBoV NP-1基因高度保守,在不同地区和不同时期的流行株间变异较小,可作为实时荧光定量PCR等方法的检测标记.

Abstract：

Objective To investigate the possible existence of HBoV in children with acute respiratory infections in Nanjing area and explore its relationship with clinical characteristics.Methods A total of 397 nasopharyngeal secretion samples were collected from children with acute respiratory infection,admitted from July 2009 to June 2010 in Nanjing Children'S Hospital affiliated to Nanjing Medical University,and 50 cases of children without symptoms of respiratory infection were recruited as control group,whose nasopharyngeal secretion samples were also collected.HBoV was determined by real-time fluorescence quantitative PCR.MP and CT were detected by real-time fluorescence quantitative PCR in those HBoV-positive samples.RSV,ADV,IVA,IVB,PIV-1,PIV-2,PIV-3 and hMPV were detected by direct antigen-specific immunofluorescence assays.HBoV NP-1 fragments were amplified and sequenced in 5 HBoV positive samples randomly selected.The results were compared with the known GenBank sequence,and thereby the phylogenetic tree was established.The epidemiological characteristics,clinical presentation and the final clinical diagnosis of HBoV were analyzed according to the clinical data of the HBoV-positive patients.Results Thirty-three HBoV-positive cases were detected by real-time fluorescence quantitative PCR method with a positivity rate of 8. 3% ( 33/397 ). Among the 33 HBoV-positive cases, 19 cases (57.6%) were multiple infections with HBoV and other pathogens, the top three of which were MP (27.3% ,9/33 ),RSV (24.2% , 8/33 ) and PIV-3 ( 12. 1% ,4/33 ). Affected children aged from 7 to 36 months old accounted for 75.8% of the total ( 25/33 ). The measured HBoV NP-1 gene sequences of 5 specimens were consistent,indicating a high homology (99% to 100% ) with the stl, st2 and WHL-1. Conclusions HBoV is one of the pathogens of children's acute respiratory infections in Nanjing. HBoV NP-1 gene is highly conserved,with little variation in different seasons and in different regions and therefore can be used as a marker for real-time fluorescence quantitative PCR and other methods.     

重症监护病房患者获得性下呼吸道感染病原菌特点及耐药性分析

目的分析2010～2011重症监护病房(ICU)患者获得性下呼吸道感染病原菌特点及耐药性情况,为临床合理选用抗生素治疗提供指导依据。方法对374例获得性下呼吸道感染患者的痰标本,分离出的病原菌进行鉴定和药敏最小抑菌浓度(MIC)检测,综合分析主要感染病原菌特点。结果 ICU患者获得性下呼吸道感染病原菌革兰阴性菌占73.8%,革兰阳性菌13.9%,真菌占12.3%,抗生素耐药性有上升趋势。结论加强实验室的病原菌鉴定和耐药性监控,对预防和控制ICU获得性下呼吸道感染、减少抗生素的滥用、降低病原菌耐药性有着重要的意义。     

老年呼吸道感染病原菌分布及其耐药性分析

目的探讨老年呼吸道感染常见病原菌分布及其耐药性。方法采用常规痰培养方法检出病原菌,用单纸片扩散法检测药敏。结果共分离出致病菌444株,其中以革兰阴性菌为主者占总数的71.85%,革兰阳性球菌占总数的12.16%,各种致病性真菌占总数的15.99%。革兰阴性菌对亚胺培南的耐药率最低,其次为环丙沙星与阿米卡星。结论临床必须注意病原菌的检测,动态掌握常见的致病菌及细菌的变迁,合理应用抗生素,减少耐药性播散。     

ICU下呼吸道感染细菌分类及耐药性分析

目的通过对我院ICU下呼吸道感染的患者痰标本所培养的细菌分类及对抗菌药物耐药情况进行调查,为临床合理使用抗菌药物提供依据。方法回顾性分析2009年1月至2010年12月在我院ICU住院的下呼吸道感染患者培养出的1149株细菌及其耐药性,采用WHONET5．4软件对数据进行分析。结果革兰氏阴性杆菌是主要致病菌（82．2％）。前6位的病原菌分别为铜绿假单胞菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌、肺炎克雷伯菌、粘质沙雷菌和大肠埃希菌。革兰阳性球菌中以耐甲氧两林金葡萄球菌为主（6．7％）。分离出的革兰氏阴性杆菌敏感的抗菌药物有阿米卡星、哌拉西林／舒巴垃等;革兰氏阳性球菌尤其是耐甲氧两林金葡菌对青霉素、左氧氟沙星等耐药,但对万古霉素、利奈唑胺敏感。结论呼吸道感染是医院感染的危险因素之一。ICU呼吸道标本分离的革兰阴性杆菌的耐药率普遍较高,且以多种抗生素耐药的非发酵菌为主,应引起临床医生的重视。     

儿科心脏重症监护病房患儿呼吸道感染病原菌的分布及耐药性研究

目的：探讨儿科心脏重症监护病房（CICU）呼吸道感染常见病原菌的分布及耐药情况,为临床合理选用抗菌药物提供参考。方法回顾性分析该医疗中心2011年1月至2012年12月1350例 CICU 下呼吸道感染患儿痰液标本培养及药敏检测结果。结果1350例痰标本中,共培养获得病原菌490株,其中革兰阴性杆菌288株（58．78％）,革兰阳性球菌140株（28．57％）,真菌62株（12．65％）。革兰阴性杆菌以肺炎克雷伯菌为主（62株,占12．65％）,其次为卡他布兰汉菌、铜绿假单胞菌、大肠埃希菌。大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶（ESBLs）菌株阳性率分别为73．33％和66．13％。革兰阳性球菌以金黄色葡萄球菌为主（65株,占13．27％）,其次为肺炎链球菌。耐甲氧西林金黄色葡萄球菌（MRSA）占24．62％。结论金黄色葡萄球菌、肺炎链球菌、肺炎克雷伯菌为 CICU 患儿呼吸道感染的主要病原菌,且存在多重耐药菌感染,根据病原菌种类及药敏结果合理应用抗菌药物是有效控制危重病患儿感染和减少耐药菌株产生的重要手段。     

肺结核患者合并肺部感染的病原菌分布及耐药性分析

目的探讨肺结核患者合并肺部感染的病原菌分布特点及耐药性,为临床合理用药和控制医院内感染提供依据。方法对2009年1月至2011年12月该院肺结核患者合并肺部感染时下呼吸道标本中分离出的阳性标本进行病原菌及耐药性分析。结果分离病原菌510株,其中革兰阴性杆菌占65.88%,真菌占19.02%,革兰阳性球菌占15.10%。感染前5位病原菌为铜绿假单胞菌(18.04%)、肺炎克雷伯菌(11.96%)、鲍曼不动杆菌(11.18%)、金黄色葡萄球菌(10.39%)和白假丝酵母菌(10.00%)。革兰阴性杆菌对氨苄西林、头孢唑啉耐药率大于97.00%。铜绿假单胞菌对亚胺培南耐药率(15.22%)最低,鲍曼不动杆菌对头孢哌酮/舒巴坦耐药率(21.05%)最低,肺炎克雷伯菌、阴沟肠杆菌、大肠埃希菌对亚胺培南全部敏感(100.00%),革兰阳性球菌对万古霉素敏感率为100.00%。结论革兰阴性杆菌、真菌是该院肺结核患者合并肺部感染的常见病原菌,多药耐药性较高,临床医生应根据药敏试验结果选择合理的抗菌药物。     

重症监护病房下呼吸道感染病原茵耐药分析及对策

目的对重症监护病房下呼吸道感染患者痰培养进行调查与分析,为控制下呼吸道患者感染提供依据和对策。方法采用Ⅵ1EK60全自动微生物分析仪,对2010年lO月至20lO年12月重症监护病房收治65例病人的痰标本进行培养。结果共捡出病原茵182株,其中G一茵152株。G＋茵30株;G＋茵前六位的为铜绿假单胞茵、大肠埃希菌、阴沟肠杆菌、鲍氏不动杆茵、肺炎克雷伯杆茵、嗜麦芽窄食单胞茵,分别占22％、11％、9．3％、8．8％、7．1％、6．6％;G＋茵前三位的是金黄色葡萄球茵、D群链球菌和表皮葡萄球茵。分别占7．1％、6．6％和1．6％。G＋茵中铜绿假单胞茵耐药严重．大肠埃希茵、鲍氏不动杆菌、阴沟肠杆菌也普遍耐药严重,尤其近几年鲍氏不动杆菌耐药有上升趋势。金黄色葡萄球茵是感染最主要的G＋球茵,对苯唑西林耐药率高达76％,万古霉素仍是治疗金葡茵最敏感药物。结论制定科学、合理、规范的抗茵药物使用制度,减少对病原茵耐药的抗茵药物压力;按照隔离传染源、切断传染途径和保护易感者的原则对耐药茵感染患者实行隔离治疗;严格执行预防呼吸机相关性肺炎的管理等措施达到控制耐药茵传播和聚集流行。     

呼吸道感染病原菌分布及耐药分析

目的了解呼吸道感染致病茵茵谱及耐药性。方法对诊断为下呼吸道感染的住院患者合格211份痰标本进行细菌学检查，阳性茵采用法国梅里埃生物公司细菌鉴定条鉴定。采用K-B纸片扩散法进行药敏试验。结果211份痰标本分离出致病菌216株，以G^-茵为主，占43．5％，G^ 茵占27．3％；表皮葡萄球菌、铜绿假单胞茵、其他假单胞茵、流感嗜血杆菌和肺炎克雷伯杆菌。占分离茵前5位，分别为13．8％、8．3％、8．8％、5．1％、5．1％。药敏结果提示D群链球菌、肠球菌、其他假单胞茵、肺炎克雷伯和鲍曼不动杆茵对多种抗生素呈现高比例耐药。铜绿假单胞茵对三代头胞、喹诺酮及氨基甙类仍敏感。万古霉素对G^ 茵高度敏感。结论呼吸道感染以G^-茵为主，其比例较以往报道下降，耐药率较高，且多重耐药。临床宜根据药敏结果选择抗生素并合理使用。     

ICU机械通气相关下呼吸道感染患者的病原菌分析

目的　分析ICU机械通气引发下呼吸道院内感染病原体的构成及其耐药情况。方法　对 1998年 1月～ 2 0 0 1年 12月间ICU收住的 177例机械通气引发下呼吸道院内感染患者的感染菌及耐药情况进行回顾性调查分析。结果　检出感染菌 383株 ,其中革兰阴性细菌 (G-菌 ) 2 16株 (5 6 .4 % ) ,革兰阳性细菌 (G 菌 ) 117株(30 .5 % ) ,真菌 5 0株 (13.1% )。不少菌株的药敏结果显示多重耐药。结论　ICU机械通气引发下呼吸道院内感染病原体以G-菌为主 ,其药敏试验呈多重耐药 ,临床应重视病菌的准确鉴定 ,合理使用抗生素     

老年脑梗死患者尿路感染的病原菌分布及耐药性分析

目的探讨老年脑梗死患者尿路感染的病原菌分布及耐药特性,为临床合理使用抗菌药物提供科学依据。方法收集住院老年脑梗死患者尿路感染病原菌183株进行细菌鉴定,并用K-B纸片法作药敏分析。结果老年脑梗死患者尿路感染病原菌以革兰阴性杆菌为主(72.1%),分别为前3位的是大肠埃希菌(49.7%)、肠球菌属(10.9%)和肺炎克雷伯菌(10.4%.)。细菌对各种抗菌药物有不同程度的耐药率,表现为多重耐药。结论革兰阴性杆菌为尿路感染的主要病原菌,对常用抗菌药物耐药率呈上升趋势,细菌培养和药敏分析对指导临床合理使用抗菌药物,选择有效抗菌药物治疗具有重要意义。