连续4年ICU患者经纤维支气管镜取痰分离病原菌及其耐药性

发布时间：2018-12-17 00:42

【摘要】：目的了解重症监护病房(ICU)患者下呼吸道病原菌分布及耐药特点,为临床治疗提供依据。方法回顾性分析2011—2014年某院外科ICU患者纤维支气管镜取痰分离病原菌情况,以及药物敏感性。结果 2011年1月1日—2014年12月31日共检出病原菌3 454株,革兰阴性(G-)菌占84.11%,革兰阳性(G+)菌占14.50%,真菌占1.39%。产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌、克雷伯菌属细菌检出率:2011—2014年分别为38.46%~73.33%、26.95%~37.06%。肠杆菌科细菌对亚胺培南、美罗培南的耐药率较低(20.00%);鲍曼不动杆菌的耐药率高于铜绿假单胞菌,两种菌对阿米卡星的耐药率最低(3.32%~37.16%);葡萄球菌中均未发现对万古霉素、利奈唑胺耐药菌株。2011—2014年耐甲氧西林金黄色葡萄球菌(MRSA)检出率为42.86%~61.22%,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率为86.96%~91.67%;屎肠球菌的耐药率高于粪肠球菌,未发现对万古霉素耐药的粪肠球菌和屎肠球菌;真菌以白假丝酵母菌为主。结论 ICU下呼吸道分离病原菌耐药性日趋严重,临床医生在合理应用抗菌药物同时应重视非抗菌药物感染控制策略。
[Abstract]:Objective to investigate the distribution and drug resistance of pathogens in lower respiratory tract of (ICU) patients in intensive care unit (ICU), and to provide evidence for clinical treatment. Methods the sputum isolation and drug sensitivity of ICU patients in a hospital from 2011 to 2014 were analyzed retrospectively. Results from January 1, 2011 to December 31, 2014, a total of 3 454 strains of pathogenic bacteria were detected. Gram-negative (G-) bacteria accounted for 84.11%, Gram-positive (G) bacteria accounted for 14.50, fungi accounted for 1.39%. Escherichia coli producing extended-spectrum 尾 -lactamases (ESBLs) and Klebsiella spp.: 38.46% in 2011-2014, 73.33% and 26.9595% (37.06%) in 2011-2014, respectively. The resistance rate of Enterobacteriaceae to imipenem and meropenem was lower (20.00%), Acinetobacter baumannii was higher than Pseudomonas aeruginosa, and the resistance rate of two strains to amikacin was the lowest (3.32% 37.16%). No vancomycin and linazolamide resistant strains were found in Staphylococcus aureus. The (MRSA) detection rate of methicillin-resistant Staphylococcus aureus in 2011-2014 was 42.86% and 61.22%, respectively. The (MRCNS) positive rate of methicillin-resistant coagulase negative staphylococci was 86.96 and 91.67; The drug resistance rate of Enterococcus faecium was higher than that of Enterococcus faecalis, no vancomycin resistant Enterococcus faecalis and Enterococcus faecium were found, and the main fungi were Candida albicans. Conclusion the drug resistance of pathogenic bacteria isolated from lower respiratory tract of ICU is becoming more and more serious. The clinicians should pay attention to the control strategy of non-antimicrobial infection in the rational use of antimicrobial agents.
【作者单位】：新疆医科大学第一附属医院;
【基金】：国家自然基金(81160232)
【分类号】：R446.5

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