呼吸重症监护室机械通气患者下呼吸道感染病原菌分布及耐药性特点

目的了解呼吸重症监护室(RICU)机械通气患者下呼吸道感染的病原菌分布及耐药性特点,以指导临床用药。方法对中南大学湘雅二医院呼吸科2000年1月至2007年2月RICU病房178例机械通气患者的临床资料及其下呼吸道感染病原菌构成及药物敏感性结果进行分析。抗生素敏感性测定采用Kribry-Bauer(KB)纸片法,最低抑菌浓度(MIC)测定采用琼脂二倍稀释法。结果178例患者共分离出菌株326株。培养结果以革兰阴性杆菌为主(255株,78.2%),其中铜绿假单胞菌、不动杆菌为主要革兰阴性病原菌。真菌占第二位,共54株,占16.6%,以白色念珠菌为主。革兰阳性球菌占第3位(17株,5.2%),以金黄色葡萄球菌为主。同时获得2种以上细菌的107例,占42%。对革兰阴性杆菌敏感性在70%以上的有美洛培南、亚胺培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、阿米卡星。万古霉素对革兰阳性球菌的敏感性为100%。结论RICU患者年龄大,多有基础疾病;革兰阴性杆菌(铜绿假单胞菌、不动杆菌)和真菌为机械通气患者主要致病菌;美洛培南、亚胺培南、头孢哌酮/舒巴坦、阿米卡星等抗生素是治疗RICU下呼吸道感染的有效抗生素;我院RICU患者混合病原菌感染较多,且存在多重耐药,应动态监测细菌的耐药性,合理选择抗生素。

Distribution of bacteria and drug-resistance to antibiotics in patients with lower respiratory tract infections diseases in RICU.

Objective To investigate the distribution,the drug-sensitivity tests and drug-resistance of bacteria in patients with lower respiratory tract infections diseases in respiratory intensive care units(RICU).Methods Retrospective study of the clinical data,the distribution and the drug-sensitivity of bacteria of 178 cases with mechanical ventilation in RICU.The drug-sensitivity were examined by Kribry-Bauer(KB)paper method and minimal-inhibitory-concentration(MIC)by agar double dilute method.Results A total of 326 strains bacteria were obtained in 178 patients.Among 326 strains G-bacteria were the most common kinds of bacteria(78.2%);main kinds of the G-bacteria were pseudomonas areuginosa(30.4%)and baumanii(23.0%);fungus was the second commonest kind of bacteria(16.6%).Most of the G bacteria were staphycoccus aureus.In 107 cases more than two kinds of bacteria were obtained.The drug sensitivity test in vitro showed that these strains were multiresistant to commonly used antibiotics,and drugs whose sensitive rate was over 70% included meropenem,impienem,cefoperazone/sulbactam,amikacin and piperacillin/tazabactam,the sensibility of vancomycin to G bacteria being 100%.Conclusion Pseudomonas areuginosa,baumanii and fungus are the main pathogens of the patients in RICU;meropenem,impienem,cefoperazone/sulbactam,amikacin and vancomycin are effctive antibiotics for treating lower respiratory tract infection in RICU.There is mixed infection by various bacteria,and some strains are multiresistant.We should monitor drug-sensitivity to bacteria dynamic and use antibiotics reasonably.