ICU中重症肺炎病原菌变迁及药物敏感情况研究

目的分析重症监护病房（ICU）中重症肺炎患者细菌变迁及药物敏感情况,为临床治疗和科学使用抗菌药物提供参考。方法对2011～2012年ICU诊治的107例重症肺炎患者的痰培养结果进行回顾性统计,分析重症肺炎患者病原菌变迁及药物敏感变化情况。结果共分离出细菌237株,前5位分别是大肠埃希菌40株、铜绿假单胞菌32株、金黄色葡萄球菌26株、鲍曼不动杆菌24株、肺炎克雷伯菌18株;2012年全耐药鲍曼不动杆菌占61.5%,高于2011年的18.2%（P〈0.05）;药敏试验结果显示,前5位细菌均呈多重耐药性。结论 ICU中重症肺炎细菌以革兰阴性菌为主,2012年与2011年比较,常见细菌耐药现象较为严重,而且呈现上升趋势,全耐药鲍曼不动杆菌显著升高,提示要及时监测ICU中重症肺炎病原菌变迁及药物敏感情况,结合药敏试验结果合理选择抗菌药物。

Study on transition and drug sensitivity of pathogenic bacteria of patients admitted to ICU with severe pneumonia

Objective To analyze the transition and drug sensitivity of pathogenic bacteria of patients admitted to the intensive care unit （ICU） with severe pneumonia in order to provide reference for clinical treatment and scientific use of antibacterial drugs. Methods Retrospective statistics was made for sputum culturing results of total 107 patients admitted to ICU with severe pneumonia from 2011 to 2012, and the transition and drug sensitivity of pathogenic bacteria of the patients were analyzed. Results Total 237 strains of bacteria were isolated, and the top five ones include ： 40 strains of escherichia coli, 32 strains of pseudomonas aeruginosa, 26 strains of staphylococcus aureus, 24 strains of acinetobacter baumannii, and 18 strains of klebsiella pneumoniae; pandrug-resistant acinetobacter baumannii （PRAB） in 2012 accounted for 61.5% , higher than that in 2011 （ 18.2%, P 〈 0. 05 ）. Drug sensitivity test results showed that the top five kinds of bacteria were nmlti-drug resistant. Conclusion The bacteria of patients admitted to ICU with severe pneumonia are mainly gram-negative bacteria. According to the comparison of the bacteria in 2012 with those in 2011, drug resistance of usual bacterial was becoming serious increasingly and that of pandrug-resistant acinetobacter baumannii increased significantly, and this shows that the transition and drug sensitivity of pathogenic bacteria of patients admitted to ICU with severe pneumonia should be monitored timely and antibacterial drugs should be selected rationally in combination with the results of drug sensitive test.