神经科监护病房患者并发肺部感染致病菌及耐药性研究

目的了解神经科监护病房(NCU)住院患者并发肺部感染病原菌谱及细菌耐药性。方法对我院2001年1月至2002年6月85例神经科监护病房患者并发肺部感染进行痰菌分离，阳性菌药敏试验采用K-B纸片法。结果经培养鉴定共取得207株致病菌．其中以革兰阴性杆菌为主，占68．51％，阳性球菌占30．91％，真菌1例，占0．48％。主要致病菌依次为：金黄色葡萄球菌占14．49％，铜绿假单胞菌占14．49％，肺炎型肺炎克雷伯氏菌占8．7％，阴沟肠杆菌占6．76％，产气肠杆菌占6．28％，药敏结果表明细菌耐药明显增强，金黄色葡萄球菌对万古霉素高度敏感．大多数革兰阴性杆菌对亚胺硫霉素仍保持较高敏感。结论神经科监护病房患者并发肺部感染主要致病菌以耐甲氧西林金黄色葡萄球菌及铜绿假单胞菌为主，细菌耐药性明显增强，临床上应加强病原菌培养及药敏监测，以指导临床科室合理使用抗生素。

Investigation of pathogenic bacteria for pulmonary infections and their drug resistance in neurological intensive care unit]

OBJECTIVE: To investigate the pathogenic bacterial spectrum responsible for pulmonary infections and their drug resistance in patients admitted to neurological care unit. METHODS: Sputum specimens were obtained from patients who developed pulmonary infections in neurological intensive care unit between January, 2001 and June, 2002 for bacterial culture and isolation. K-B paper disc method was employed for determination of the drug sensitivity of the bacterial isolates. RESULTS: In the 207 strains obtained from the patients, the majority (68.51%) were Gram-negative and 30.91/ Gram-positive bacteria, with fungi detected in one case (0.48%). The major pathogenic bacteria for pulmonary infection were, in the order of frequency, Staphylococcus aureus(14.49%), Pseudomonas aeruginosa (14.49%), Klebsiella pneumoniae (8.7%), Enterobacter cloacae (6.76%), and Enterobacter aerogenes (6.28%). Drug sensitivity tests showed increased drug resistance of the bacteria, but Staphylococcus aureus still remained sensitive to vancomycin and most of the Gram-negative bacillus sensitive to imipenem. CONCLUSION: The major pathogenic bacteria causing pulmonary infections in neurological intensive care unit are Staphylococcus aureus and Pseudomonas aeruginosa, and their drug resistance is obviously increased, suggesting the necessity of strengthening bacterial surveillance and more adequate clinical use of antibiotics.