ICU下呼吸道感染细菌分类及耐药性分析

目的通过对我院ICU下呼吸道感染的患者痰标本所培养的细菌分类及对抗菌药物耐药情况进行调查，为临床合理使用抗菌药物提供依据。方法回顾性分析2009年1月至2010年12月在我院ICU住院的下呼吸道感染患者培养出的1149株细菌及其耐药性，采用WHONET5．4软件对数据进行分析。结果革兰氏阴性杆菌是主要致病菌（82．2％）。前6位的病原菌分别为铜绿假单胞菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌、肺炎克雷伯菌、粘质沙雷菌和大肠埃希菌。革兰阳性球菌中以耐甲氧两林金葡萄球菌为主（6．7％）。分离出的革兰氏阴性杆菌敏感的抗菌药物有阿米卡星、哌拉西林／舒巴垃等；革兰氏阳性球菌尤其是耐甲氧两林金葡菌对青霉素、左氧氟沙星等耐药，但对万古霉素、利奈唑胺敏感。结论呼吸道感染是医院感染的危险因素之一。ICU呼吸道标本分离的革兰阴性杆菌的耐药率普遍较高，且以多种抗生素耐药的非发酵菌为主，应引起临床医生的重视。

Bacteriium features and the drug resistance in lower respiratory tract infection patients in ICU

Objective To evaluate the pathogens spectrum and drug- resistance rates of bacteria isolated from the lower respiratory tract infection patients in ICU, and provide reference for antimicobial rational applicaion in clinic. Methods Clinieal data of 1149 bacterial strain with lower respiratory tract infection from January 2009 to December 2010 were reviewed. The pathogen types and antibiotic sensitivity of pathogens isolated from cultured sputum collected from the patients were analyzed. Data were analyzed by WHONET 5.4 software.. Results Gram- negative bacilli is the major patyogen （82.2%）. The first six bacterias were Psendomonas aeruginosa, Acinetobacter baumannii, stenotrophomonss mahophilia, k pneumoniae, and Serratia marceseans. Methieillin - resistant Staphylococcus aurens is the main croorganism in Grampositive cocci（6.7 % ）. The effective agents against Gram - negative bacteria were Amikacin ; Gram - positive cocci, especially the Methicillin - resistant Staphylococcus aureus were against Penicillin, Levolloxacin, but it was sensitive to Vaneomyeins Linezolids. Conclusion The respiratory infection is one of the hazards in nosocomialin fection,drug resistant rate of Gram - negative bacilli from respiratory specimen in ICU is generally high, and the most strains are themlti- resistant non - fermentatives,which should attract the clinician＇ s more attention.