ICU下呼吸道医院感染G~-杆菌分布特点与耐药性研究

目的探讨重症监护病房(ICU)患者下呼吸道医院感染革兰阴性(G-)杆菌分布特点与耐药性动态变化。方法监测2005—2012年ICU患者下呼吸道医院感染痰标本分离的G-杆菌和耐药性,将前、后4年分为两个观察组进行统计学分析。结果前后两组分离G-杆菌分别为676株和233株,前3位是:鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌,分别占总G-杆菌64.64%(437/676)和82.40%(192/233)。两组动态观察显示:前3位细菌构成比有显著统计学差异(P<0.01);鲍曼不动杆菌对部分抗菌药物耐药性显著增加(P<0.05),肺炎克雷伯菌对阿米卡星、头孢哌酮-舒巴坦耐药性显著降低(P<0.05);铜绿假单胞菌对亚胺培南、哌拉西林、哌拉西林-他唑巴坦耐药性显著降低(P<0.05)。结论 ICU下呼吸道医院感染G-杆菌中鲍曼不动杆菌(经验性用药可用头孢哌酮-舒巴坦、氨苄西林-舒巴坦、阿米卡星)、肺炎克雷伯菌(经验性用药可用阿米卡星、头孢哌酮-舒巴坦)、铜绿假单胞菌(经验性用药选择范围较宽)仍为重要致病菌。

A study of distribution and drug resistance of Gram-negative bacteria in patients with lower respiratory tract infection in ICU

Objective To study the aheration of distribution and drug resistance rates of Gramnegative bacteria among the patients with lower respiratory tract infection in intensive care unit （ICU）. Methods From 2005 to 2012, Gram-negative bacteria bifurcated groups were collected from the patients with lower respiratory tract infection in the ICU. The data were statistically summarized. Results Totally 676 and 233 strains of Gram-negative bacteria were isolated from the ICU in the former and latter 4 years, respectively. The first three bacteria were A. Baumannii, K. pneumoniae and P. aeruginosa, accounting for 64.64% （437/676） and 82.40% （ 192/233 ）. The data showed that constitutive ratio of the first three bacteria were different （ P 〈 0. 01 ）. The drug resistance of A. Baumannii against partial antibiotics was increased （P 〈 0.05 ）. The drug resistance of K. pneumoniae against amikacin and cefoperazone/sulbactam was decreased （ P 〈 0.05 ）, and so was that of P. aeruginosa against imipenem, piperacillin and piperacillin/ tazobactam （P 〈 0.05）. Conclusion A. Baumannii （ empiric therapy include cefoperazone/sulbactam, ampiciUin/sulbactam and amikacin）, K. pneumoniae （empiric therapy include amikacin and cefoperazone/sulbactam） and P. aeruginosa （can choose from a wide range of options） are still the important pathogens of Gram-negative bacteria among the patients with lower respiratory tract infection in ICU.