重症监护病房下呼吸道感染常见革兰阴性杆菌的耐药分析

目的 了解重症监护病房(ICU)下呼吸道感染常见革兰阴性杆菌的耐药性,为临床合理用药提供依据.方法 采集2004-2007年ICU下呼吸道感染患者的痰标本,按NCCLS标准进行药敏试验.结果 ICU下呼吸道感染病原菌中革兰阴性杆菌占75.2%,常见为:铜绿假单胞菌(42.7%),鲍氏不动杆菌(16.3%),嗜麦芽寡养单胞菌(10.4%),大肠埃希菌(10.0%),肺炎克雷伯菌(6.7%);大肠埃希菌和肺炎克雷伯菌产ESBLs从2004年的54.5%和37.5%升至2007年的65.6%和52.7%,非产ESBLs组细菌对氨基糖苷类、喹诺酮类及第三、四代头孢菌素的耐药性明显低于产ESBLs组;非发酵革兰阴性杆菌对大多数抗菌药物高度耐药.结论 ICU下呼吸道革兰阴性杆菌耐药情况严重,加强耐药性检测,合理使用抗菌药物十分重要.

Antibiotic Resistance among Gram-negative Bacilli in Intensive Care Unit Patients with Lower Respiratory Tract Infection

OBJECTIVE To investigate the antimicrobial resistances of Gram-negative bacilli isolated from patients with lower respiratory infection in intensive care unit (ICU), so as to provide reasonable selections for antibiotic in clinical treatment. METHODS The phlegm specimens from ICU inpatients with lower respiratory tract infection were collected from 2004 to 2007, and drug sensitivity test was performed according to NCCLS standards. RESULTS Gram-negative bacilli were accounted for 75.20% of total strains. The most predominant pathogens were Pseudomonas aeruginosa (42.7%), Acinetobacter baumannii (16.3%), Sternotrophomonas maltophilia (10.4%), Escherichia coli (10.0%), and Klebsiella pneumoniae (6.7%). The prevalence of ESBLs in E. coli and K. pneumoniae increased from 54.5% and 37.5% in 2004 to 65.6% and 52.70% in 2007. ESBLs non-producing strains showed lower resistance rates to the aminoglycosides, quinolones and the third and fourth generation cephalosporin than those of ESBLs producing strains. Nonfermentative Gram-negative bacilli were very highly resistant to most antimicrobial agents. CONCLUSIONS The drug resistance rates of Gram-negative bacilli of lower respiratory tract are serious. It is important to investigate the antimicrobial resistances of pathogenic bacteria and rationally use of antibiotics.