连续4年ICU患者经纤维支气管镜取痰分离病原菌及其耐药性

目的了解重症监护病房（ICU）患者下呼吸道病原菌分布及耐药特点，为临床治疗提供依据。方法回顾性分析2011—2014年某院外科ICU患者纤维支气管镜取痰分离病原菌情况，以及药物敏感性。结果2011年1月1日—2014年12月31日共检出病原菌3 454株，革兰阴性（G-）菌占84.11%，革兰阳性（G+）菌占14.50%，真菌占1.39%。产超广谱β 内酰胺酶（ESBLs）的大肠埃希菌、克雷伯菌属细菌检出率：2011—2014年分别为38.46%~73.33%、26.95%~37.06%。肠杆菌科细菌对亚胺培南、美罗培南的耐药率较低（＜20.00%）；鲍曼不动杆菌的耐药率高于铜绿假单胞菌，两种菌对阿米卡星的耐药率最低（3.32%～37.16%）；葡萄球菌中均未发现对万古霉素、利奈唑胺耐药菌株。2011—2014年耐甲氧西林金黄色葡萄球菌（MRSA）检出率为42.86%～61.22%，耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）检出率为86.96%～91.67%；屎肠球菌的耐药率高于粪肠球菌，未发现对万古霉素耐药的粪肠球菌和屎肠球菌；真菌以白假丝酵母菌为主。结论ICU下呼吸道分离病原菌耐药性日趋严重，临床医生在合理应用抗菌药物同时应重视非抗菌药物感染控制策略。

Distribution and antimicrobial resistance of pathogens from intensive care unit patients’ sputum obtained through fiberbronchoscope for four consecutive years

ObjectiveTo investigate the distribution and antimicrobial resistance of pathogens from lower respiratory tract in patients in intensive care unit (ICU), so as to provide reference for clinical treatment.MethodsDistribution and antimicrobial susceptibility of pathogens isolated from ICU patients’ sputum obtained through fiberbronchoscope between 2011 and 2014 were analyzed retrospectively.ResultsA total of 3 454 pathogenic strains were isolated between January 1,2011 and December 31,2014, the percentage of gram negative bacteria, gram positive bacteria,and fungi were 84.11%, 14.50%, and 1.39% respectively. The detection rates of extended spectrum β lactamase producing Escherichia coli and Klebsiella spp. in 2011-2014 were 38.46%-73.33% and 26.95%-37.06% respectively. Enterobacteriaceae strains had low resistance rates to imipenem and meropenem (<20.00%); resistance of Acinetobacter baumannii was higher than Pseudomonas aeruginosa, both had low resistance rates to amikacin(3.32%-37.16%); vancomycin and linezolid resistant strains were not found among Staphylococcus. In 2011-2014, detection rates of methicillin resistant Staphylococcus aureus(MRSA) were 42.86%-61.22%, methicillin resistant coagulase negative staphylococcus (MRCNS) were 86.96%-91.67%; resistance rates of Enterococcus faecium was higher than Enterococcus faecalis, vancomycin resistant strains were not found among Enterococcus faecalis and Enterococcus faecium; the major fungus was Candida albicans.ConclusionAntimicrobial resistance of pathogens isolated from lower respiratory tract is getting more serious, clinicians should pay attention to non antimicrobial infection control strategies in addition to rational use of antimicrobial agents.