重症医学科2613株下呼吸道感染病原体分布及耐药性

目的了解重症医学科(ICU)下呼吸道感染病原体分布及耐药性,为临床经验性治疗提供参考。方法对2011—2015年某院ICU下呼吸道标本分离的2 613株病原体进行统计及药敏分析。结果 2 613株病原体中革兰阴性菌2 308株(88.33%),革兰阳性菌236株(9.03%),真菌69株(2.64%)。居前5位的病原体依次是鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌及黏质沙雷菌,分别占33.64%、16.42%、15.19%、7.35%和4.90%。鲍曼不动杆菌对大多数抗菌药物耐药率75.00%,其中对亚胺培南耐药率为80.32%;铜绿假单胞菌、肺炎克雷伯菌及黏质沙雷菌对亚胺培南耐药率为16.08%~34.38%,对阿米卡星、头孢吡肟和哌拉西林/他唑巴坦耐药率30.00%。革兰阳性菌对万古霉素和利奈唑胺100.00%敏感。金黄色葡萄球菌和溶血葡萄球菌对苯唑西林耐药率分别为81.77%和100.00%。结论 ICU下呼吸道感染分离的病原体以革兰阴性菌为主,其中非发酵菌分离率居首位。大多数细菌耐药现象严重,临床应参照药敏结果合理选用抗菌药物。

Distribution and antimicrobial resistance of 2 613 pathogens causing lower respiratory tract infection in intensive care unit

ObjectiveTo investigate the distribution and antimicrobial resistance of pathogens causing lower respiratory tract (LRT) infection in an intensive care unit(ICU), and provide reference for empiric therapy.Methods2 613 pathogenic strains isolated from LRT of patients in an ICU in 2011-2015 were performed statistic and antimicrobial susceptibility analysis.ResultsOf 2 613 strains, 2 308（88.33％) were gram negative bacteria，236(9.03％) were gram positive bacteria, and 69(2.64％) were fungi. The top 5 pathogens were Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus, and Serratia marcescens, accounting for 33.64%，16.42%，15.19%，7.35%, and 4.90% respectively. Resistance rates of Acinetobacter baumannii to most antimicrobial agents were＞75.00%，resistance rate to imipenem was 80.32%；resistance rates of Pseudomonas aeruginosa, Klebsiella pneumoniae, and Serratia marcescens to imipenem were 16.08%-34.38%, to amikacin, cefepime, and piperacillin/ tazobactam were all＜30.00％. Susceptibility of gram positive bacteria to vancomycin and linezolid were both 100.00%. Resistance rates of Staphylococcus aureus and Staphylococcus heamolyticus to oxacillin were 81.77% and 100.00% respectively.ConclusionGram negative bacteria are the main pathogens isolated from LRT in ICU patients, and non fermentative bacteria ranked the first. Antimicrobial resistance are serious for most pathogens, antimicrobial agents should be chosen rationally according to antimicrobial susceptibility testing results.