ICU患者下呼吸道感染的细菌分布和耐药性分析

目的通过对重症监护病房（ICU）机械通气患者下呼吸道感染的细菌分布特点和耐药性分析，为临床合理应用抗生素提供依据。方法对深圳市龙岗中心医院2006年1月-2007年12月间ICU机械通气下呼吸道感染患者痰标本按《全国临床检验操作规程》分离培养，经VITEK32仪鉴定菌种，用“K-13”法作药敏试验，对结果进行分析。结果在分离的156株菌中，G-菌104株（66．7％）、G^＋菌32株（20．5％）、真菌20株（12．8％）。G-菌中以鲍氏不动杆菌、铜绿假单胞菌为多。G^＋菌以金黄色葡萄球菌为主；耐苯唑西林金葡菌和耐苯唑西林凝固酶阴性葡萄球菌分别为93．3％和91．7％。真菌以白色念珠菌为主。G-菌对亚胺培南、哌拉西林／他唑巴坦、头孢吡肟和妥布霉素较敏感；葡萄球菌属仍对万古霉素最为敏感，尚未发现耐药株。结论ICU下呼吸道感染的细菌耐药性相当普遍；细菌分布和耐药性的动态检测，对于抗生素的合理应用以及经验性治疗均为重要。

Analysis of distribution of bacteria in ICU patients with respiratory infection and drug resistance

Objective To analyse the distribution and drag resistance of pathogens in patients receiving mechanical ventilation with lower respiratory tract infection in intensive care unit（ICU）. Methods There 156 strains of bacterium isolated from the sputum and drag resistance in patients receiving mechanical ventilation with lower respiratory tract infection in ICU from Jan 2006 to Dee 2007 were analyzed retrospectively. Results The rate of the gram - negative bacilli were 104 （66. 7% ） ,and that of the gram - positive coccus were 32（20.5% ） and fungi were 20（ 12.8% ）. The main gram - negative bacilli were Acinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumoniae, Escherichia coli and Stenotrophomonas maltophilia. The strains of the K. pneurnoniae with ESBLs and E. coli with ESBLs were 69.2% and 70.0% respectively. Among gram - positive coccus the Stphylococcus aureus was predominant, metheciUin - resistant S. aureus （MRSA） and methecillin - resistant eoagulase - negative Staphylococci （MRS） was 93.3% and 91.7% respectively. Candida albicans was the main fungi. There lower drag resistance rate of the gram - negative bacilli to Imipenem, Piperacillin/tazobaetam, Cefepime and Tobramycin was obsereved All stphylococcus were sensitive to vancomycin and no resistant strain was found. Condusion The drag resistance in patients with lower respiratory tract infection in ICU was common. It is of great importance to reasonable use of antibiotics to reduce the incidence of drag resistance and enhancing therapeuticeffect.