强化康复单元重症患者下呼吸道分泌物病原菌培养及药敏试验观察

发布时间：2018-05-21 00:41

本文选题：强化康复单元 + 重症患者　；参考：《山东医药》2017年39期

【摘要】：目的观察在强化康复单元住院治疗的重症患者下呼吸道分泌物的病原菌培养和药敏试验情况。方法在医院康复科强化康复单元治疗的重症患者368例,通过无菌吸痰管或纤维支气管镜于气道深部负压吸引下采集下呼吸道分泌物,进行病原学培养和药敏试验,观察2013~2016年纳入患者下呼吸道分离菌株的构成情况、耐药性特点及变化趋势。结果共分离出菌株368株,其中革兰阴性菌318株、革兰阳性菌50株。革兰阴性菌主要为铜绿假单胞菌(181株)、鲍曼不动杆菌(59株)、肺炎克雷伯菌(26株),革兰氏阳性菌以金黄色葡萄球菌(36株)为主。上述菌株对临床常用抗菌药物均存在普遍的多重耐药性,其中以鲍曼不动杆菌的耐药情况最严重。分离出的3种最常见革兰阴性菌中均可见碳青霉烯类耐药的菌株,但对多黏菌素的耐药率较低。金黄色葡萄球菌中耐甲氧西林的金黄色葡萄球菌多见,耐药性也较普遍,但尚未发现对替考拉宁、万古霉素、利奈唑胺耐药的菌株。在上述主要分离菌株中,共检出多重耐药菌142株,其中90株为多重耐药菌(MDR)、51株为广泛耐药菌(XDR)、1株为泛耐药菌(PDR)。鲍曼不动杆菌中MDR/XDR/PDR所占的比例最高(超过80%)。肺炎克雷伯菌中MDR所占比例为50%~100%,金黄色葡萄球菌中MDR所占比例为33.3%~75.0%。分离菌株对大部分常用抗菌药物的耐药率在2016年较2013年有升高趋势。结论在IRCU住院治疗的重症患者下呼吸道分泌物分离菌株以革兰阴性菌为主,并以铜绿假单胞菌占绝对优势,大部分分离菌株均有较强耐药性,且多为多重耐药菌株,MDR、XDR常见。
[Abstract]:Objective to observe the pathogen culture and drug sensitivity test of lower respiratory tract secretion in intensive rehabilitation unit inpatients. Methods 368 cases of severe patients treated with intensive rehabilitation unit in the hospital rehabilitation department were collected the lower respiratory tract secretions under the suction of deep negative pressure of the airway by aseptic sputum suction tube or fiberoptic bronchoscope, and the pathogen culture and drug sensitivity test were carried out. To observe the composition, drug resistance characteristics and change trend of isolates from lower respiratory tract of patients from 2013 to 2016. Results 368 strains were isolated, of which 318 were Gram-negative bacteria and 50 Gram-positive bacteria. Gram-negative bacteria were mainly Pseudomonas aeruginosa (181 strains), Acinetobacter baumannii (59 strains), Klebsiella pneumoniae (26 strains) and Gram-positive bacteria (36 strains of Staphylococcus aureus). The multidrug resistance of Acinetobacter baumannii was the most serious. Carbapenem resistant strains were found in the three most common Gram-negative strains, but the resistance rate to polymyxin was low. Methicillin-resistant Staphylococcus aureus is more common in Staphylococcus aureus and its resistance to methicillin-resistant Staphylococcus aureus is more common, but no strains resistant to teicoplanin, vancomycin and linazolamide have been found. Among the main isolates, 142 multidrug resistant strains were identified, of which 90 were multidrug resistant strains, 51 were XDRN strains and 1 was pan-resistant strain PDRN. Acinetobacter baumannii has the highest proportion of MDR/XDR/PDR (more than 80%). The proportion of MDR in Klebsiella pneumoniae was 50 and that in Staphylococcus aureus was 33.3% and 75.0% respectively. The resistance rate of the isolates to most commonly used antimicrobial agents increased in 2016 than in 2013. Conclusion Gram-negative bacteria are the main isolates of lower respiratory tract secretion in IRCU patients, and Pseudomonas aeruginosa is the dominant strain. Most of the isolates have strong drug resistance, and most of them are multidrug resistant strains.
【作者单位】：南方医科大学南方医院;
【分类号】：R446.5;R56

【相似文献】