急性呼吸窘迫综合征患者下呼吸道感染病原菌分布及耐药性特点

目的 了解呼吸重症监护病房(RICU)急性呼吸窘迫综合征(ARDS)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2003年1月-2010年12月入住于延边大学附属医院呼吸内科RICU的82例ARDS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；抗菌药物敏感性测定采用K-B纸片扩散法.结果 82例患者共分离出病原菌60株,以革兰阴性杆菌为主,占73.3％,其中鲍氏不动杆菌、肺炎克雷伯菌、大肠埃希菌为主要革兰阴性杆菌,分别占33.3％、11.7％、11.7％,真菌居第2位,占20.0％,均为白色假丝酵母菌；鲍氏不动杆菌对亚胺培南的敏感率＞50.0％.结论 革兰阴性杆菌及真菌为ARDS患者下呼吸道感染主要致病菌；鲍氏不动杆菌对多种抗菌药物耐药,应动态监测细菌的耐药性,合理选择抗菌药物.

Distribution and drug resistance of pathogenic bacteria causing lower respiratory tract infections in patients with acute respiratory distress syndrome

OBJECTIVE To investigate the distribution of bacteria and drug resistance to antibiotics in acute respiratory distress syndrome(ARDS) patients with lower respiratory tract infections in respiratory intensive care unites(RICU) and to provide the reference for clinical treatment. METHODS Retrospective study of the clinical data was performed on 82 ARDS patients in RICU from department of respiratory medicine of Yanbian University hospital,from Jun.2003 to Dec.2010.The distribution and the dug susceptibility of bacteria were explored.The drug-susceptibility was examined by Kribry-Bauer(KB) method. RESULTS A total of 60 strains of bacteria were obtained in 82 patients,and gram-negative bacilli were the main bacteria(73.3%),consisted of Acinetobacter baumannii,Klebsiella pneumoniae and Escherichia coli of 33.3%、11.7%、11.7% respectively.Fungus was the second common bacteria(20.0%),and the majority of fungus was Candida albicans.In 20 cases more than two kinds of bacteria were obtained(45.45%).The susceptibility rate of imipenem to Acinetobacter baumannii was over 50.0%. CONCLUSION Gram-negative bacteria and fungus are the main pathogens of ARDS patients with lower respiratory tract infections;A.baumannii is highly resistant to several antimicrobial agents.There is mixed infection caused by various bacteria in ARDS patients,and some strains are multi-resistant.We should monitor the dynamic drug-susceptibility to bacteria and use antibiotics reasonably.