ICU患者呼吸道感染病原菌的分布及耐药性监测

目的了解华中科技大学同济医学院附属同济医院ICU患者呼吸道感染病原菌的分布及细菌耐药性特征,指导临床合理、科学地使用抗菌药物,为有效控制危重患者肺部感染提供依据。方法回顾分析该院2004年1月至2008年12月ICU患者呼吸道感染的病原菌分布情况,并分析其耐药性变化。结果该院ICU患者呼吸道感染病原菌主要为鲍曼不动杆菌(aba)、铜绿假单胞菌(pae)和金葡菌(sau),其中泛耐药菌株有增多趋势。耐苯唑西林金葡菌(MRSA)的检出率在77.5%~100%。药敏数据显示,pae对常用抗菌药物耐药率均较高,在25.5%~95.3%;aba仅对头孢哌酮/舒巴坦耐药率低,为12.2%,但中敏率较高,为41.7%,对其他常用抗菌药物耐药率均较高。MRSA对所有的β-内酰胺类抗菌药物均耐药,苯唑西林敏感的金葡菌(MSSA)对青霉素和红霉素耐药率较高,分别为97.1%和47.2%,对其他常用抗菌药物较敏感。结论该院ICU患者呼吸道感染以aba、pae和sau为主,且耐药现象严重,对临床常用抗菌药物有多重耐药现象,临床医生应根据药敏结果合理使用抗菌药物。

Pathogen distribution in ICU with respiratory tract infection and analysis of drug resistance

Objective To investigate the distribution and antibiotic resistance of pathogen in intensive care unit with respiratory tract infection in our hospital and provide reference for clinical treatment of the patients with serious lung infection.Method The distribution and drug resistance of the pathogen isolated from respiratory tract infection patients in intensive care unit in our hospital from January 2004 to December 2008 were statistically analyzed using the retrospective investigation method.Result Most of the pathogens isolated from respiratory tract infection patients in intensive care unit in our hospital were A.baumannii,P.aeruginasa and S.aureus.More and more pathogens were resistant to all the antimicrobial agents.The prevalence of methicilin-resistant Staphylococcus（MRS） was identified as between 77.5% to 100%.Susceptibility test showed the resistant rates of P.aeruginasa to the testing drugs were between 25.5% to 95.3%.The resistant rate of A.baumannii to Cefoperazone-sulbactam was low（12.2%）,but its medium priority was high（41.7%）,while the resistant rates to other drugs were high.MRSA was resistant to all β-lactam drugs.The resistant rates of MSSA to pencillin and erymycillin were 97.7% and 47.2% respectively.MSSA was sensitive to all of the other drugs.Conclusion Most of the pathogens isolated from respiratory tract infection patients in intensive care unit in our hospital from January 2004 to December 2008 are A.baumannii,P.aeruginasa and S.aureus which are highly resistant all drugs commonly used clinically.Doctors should prescribe drugs rationally according to drug sensitivity test results.