重症监护病房下呼吸道感染病原菌分析

Analysis of pathogens in lower airways infection in intensive care units

关键词:  重症监护病房  下呼吸道感染  病原菌  耐药

Key words:  intensive care units  lower airways infection  pathogens  antibiotic resistance

摘要:

［目的］ 回顾分析重症监护病房下呼吸道感染病原菌流行及耐药现状，为临床合理应用抗生素提供依据。［方法］总结大连医科大学附属第二医院2004~2006年重症监护病房（ICU）住院患者455份痰标本及药敏结果，并与同期普通病房住院患者的结果进行比较。［结果］ICU病原菌流行谱与普通病房有明显差异，ICU分离病原菌肺炎克雷伯菌及铜绿假单胞菌对各类抗生素耐药率并未高于普通病房，而不动杆菌耐药率则明显高于普通病房。革兰阴性杆菌超广谱β-内酰胺酶检出率也明显高于普通病房。耐甲氧西林葡萄球菌MRS占98%，只对万古霉素、替考拉宁敏感。［结论］目前ICU下呼吸道病原菌中条件致病菌及多重耐药比例逐年上升。MRS推荐使用万古霉素，对产超广谱β-内酰胺酶菌株建议选用碳青霉烯类、哌拉西林/他唑巴坦，头孢哌酮/舒巴坦。

Abstract:

［Objective］To investigate the distribution and antibiotic resistence of the pathogens of lower airways in intensive care units(ICU).［Methods］A total of 455 sputum strains isolated from ICU inpatients with lower airways infections during 2004~2006 were analyzed by the WHONET5.3 for the susceptibility of pathogens.The results were compared with those from general ward inpatients.［Results］The distribution of pathogens in ICU was significantly diffirent from that in general ward.The a.baumanii rate of antibiotic resistance was significantly higher in ICU than in general ward .Klebsiella pneumoniae producing extended-spectrum beta-lactamase (ESBLs)were detected with a rate of 68%.Methicillin-resistant Staphylococcus (MRS)accounted for 98% of all Staphylococcus.［Conclusions］At present,opportunistic pathogens and multidrug resistant pathogens play a more and more important role in lower airways infection. Vancomycin is suggested for MRS ,Carbopenems and Piperacillin/tazobactam,cefoperazone/sulbactam for ESBLs-producing pathogens.