中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2009年
1期
36-39
,共4页
魏宏建%刘丽丽%肖李乐云%王雨平%黄冬%骈淮燕%祝艳翠
魏宏建%劉麗麗%肖李樂雲%王雨平%黃鼕%駢淮燕%祝豔翠
위굉건%류려려%초리악운%왕우평%황동%병회연%축염취
致病菌%抗生素%危重患者
緻病菌%抗生素%危重患者
치병균%항생소%위중환자
pathogenic bacteria%antibiotic%severe case
目的 探讨危重患者抗生素目标治疗7 d内致病菌种类和比例变化的特点.方法 对已明确致病菌并根据细菌学检验使用抗生素的100例医院获得性肺炎(HAP)患者,观察不同时间内痰标本中检测出的致病菌种类和比例的变化,并分析其与年龄、用药时间、住院时间等因素的关系.结果 共分离出295株致病菌,其中以革兰阴性(Gˉ)菌为主,占菌株数的62.4%(184/295).排在前3位的致病菌分别为铜绿假单胞菌22.4%(66/295)、耐甲氧西林金黄色葡萄球菌/耐甲氧西林表皮葡萄球菌(MRSA/MRSE)20.7%(61/295)、不动杆菌属10.5%(31/295),占菌株数的53.6%.根据细菌培养结果选用敏感抗生素1种及以上,结果发现,致病菌比例发生变化160株,种类发生变化126株;其中随抗生素使用时阃延长,致病菌比例变化逐渐下降,3～5 d致病菌比例变化较6～7 d明显,分别为72.7%、62.5%、60.0%(P＜0.01),说明治疗效果确切;而致病菌种类变化则随时间延长逐渐增多,6～7 d较3～5 d变化为甚,分别为66.0%、77.1%(P＜0.01),表现为新的非敏感菌种出现.随着抗生素应用种类的增加,致病菌种类变化呈逐渐增加的趋势.抗Gˉ菌时常出现的新菌种为白色念珠菌、MRSA;抗G+菌时常出现的新菌种为白色念珠菌、铜绿假单胞菌、阴沟肠杆菌.致病菌的变化与年龄和住院时间有关,年龄越大,住院时间越长,致病菌的种类变化越显著.结论 抗生素目标治疗7 d内即可出现新的非敏感致病菌,且抗生素使用时间越长,种类越多,致病菌的种类变化越明显;患者年龄越大,住院时间越长,致病菌的种类变化也越明显.致病菌种类的变化中白色念珠菌出现几率较高.动态监测致病菌的变化,及时调整并合理使用抗生素,对进一步认识及攻克难治性感染具有重要意义.
目的 探討危重患者抗生素目標治療7 d內緻病菌種類和比例變化的特點.方法 對已明確緻病菌併根據細菌學檢驗使用抗生素的100例醫院穫得性肺炎(HAP)患者,觀察不同時間內痰標本中檢測齣的緻病菌種類和比例的變化,併分析其與年齡、用藥時間、住院時間等因素的關繫.結果 共分離齣295株緻病菌,其中以革蘭陰性(Gˉ)菌為主,佔菌株數的62.4%(184/295).排在前3位的緻病菌分彆為銅綠假單胞菌22.4%(66/295)、耐甲氧西林金黃色葡萄毬菌/耐甲氧西林錶皮葡萄毬菌(MRSA/MRSE)20.7%(61/295)、不動桿菌屬10.5%(31/295),佔菌株數的53.6%.根據細菌培養結果選用敏感抗生素1種及以上,結果髮現,緻病菌比例髮生變化160株,種類髮生變化126株;其中隨抗生素使用時閫延長,緻病菌比例變化逐漸下降,3～5 d緻病菌比例變化較6～7 d明顯,分彆為72.7%、62.5%、60.0%(P＜0.01),說明治療效果確切;而緻病菌種類變化則隨時間延長逐漸增多,6～7 d較3～5 d變化為甚,分彆為66.0%、77.1%(P＜0.01),錶現為新的非敏感菌種齣現.隨著抗生素應用種類的增加,緻病菌種類變化呈逐漸增加的趨勢.抗Gˉ菌時常齣現的新菌種為白色唸珠菌、MRSA;抗G+菌時常齣現的新菌種為白色唸珠菌、銅綠假單胞菌、陰溝腸桿菌.緻病菌的變化與年齡和住院時間有關,年齡越大,住院時間越長,緻病菌的種類變化越顯著.結論 抗生素目標治療7 d內即可齣現新的非敏感緻病菌,且抗生素使用時間越長,種類越多,緻病菌的種類變化越明顯;患者年齡越大,住院時間越長,緻病菌的種類變化也越明顯.緻病菌種類的變化中白色唸珠菌齣現幾率較高.動態鑑測緻病菌的變化,及時調整併閤理使用抗生素,對進一步認識及攻剋難治性感染具有重要意義.
목적 탐토위중환자항생소목표치료7 d내치병균충류화비례변화적특점.방법 대이명학치병균병근거세균학검험사용항생소적100례의원획득성폐염(HAP)환자,관찰불동시간내담표본중검측출적치병균충류화비례적변화,병분석기여년령、용약시간、주원시간등인소적관계.결과 공분리출295주치병균,기중이혁란음성(Gˉ)균위주,점균주수적62.4%(184/295).배재전3위적치병균분별위동록가단포균22.4%(66/295)、내갑양서림금황색포도구균/내갑양서림표피포도구균(MRSA/MRSE)20.7%(61/295)、불동간균속10.5%(31/295),점균주수적53.6%.근거세균배양결과선용민감항생소1충급이상,결과발현,치병균비례발생변화160주,충류발생변화126주;기중수항생소사용시곤연장,치병균비례변화축점하강,3～5 d치병균비례변화교6～7 d명현,분별위72.7%、62.5%、60.0%(P＜0.01),설명치료효과학절;이치병균충류변화칙수시간연장축점증다,6～7 d교3～5 d변화위심,분별위66.0%、77.1%(P＜0.01),표현위신적비민감균충출현.수착항생소응용충류적증가,치병균충류변화정축점증가적추세.항Gˉ균시상출현적신균충위백색념주균、MRSA;항G+균시상출현적신균충위백색념주균、동록가단포균、음구장간균.치병균적변화여년령화주원시간유관,년령월대,주원시간월장,치병균적충류변화월현저.결론 항생소목표치료7 d내즉가출현신적비민감치병균,차항생소사용시간월장,충류월다,치병균적충류변화월명현;환자년령월대,주원시간월장,치병균적충류변화야월명현.치병균충류적변화중백색념주균출현궤솔교고.동태감측치병균적변화,급시조정병합리사용항생소,대진일보인식급공극난치성감염구유중요의의.
Objective To observe the changing spectrum of the pathogenic bacteria during seven-day antibiotics targeted therapy in an intensive care unit(ICU).Methods In a group of 100 patients of hospital-acquired pneumonia(HAP)with identified pathogenic bacteria undergoing antibiotic treatment according to susceptibility test,the changes in the species of the pathogens and their ratio in their sputum specimens were studied,and the relationship were analyzed the characteristic between the changes and the age,the time of medication and the length of stay.Results Among all the bacterial isolates(n=295)in ICU,the percentage of Gram-negative bacillus was 62.4%(184/295).The prevalent causative microorganisms isolated were Pseudomonas aeruginosa 22.4%(66/295),MRSA/MRSE 20.7%(61/295)and Acinetobacter spp.10.5% (31/295).When one or more than one potent antibiotic in accord with the result of sensitivity test,change in ratio of pathogens occurred in 160,and change in species in 126.When the use of antibiotics was prolonged,the change in the former became less often.The change in ratio was less in 3-5 days than that of 6-7 days,the ratio was 72.7%,62.5%,60.O%(P<0.01)respectively on the 3rd day,the 4th day and the 5th day,showing that susceptible pathogenic bacteria became less gradually,indicating that the treatment was effective,However,the change in species of pathogenic bacteria began more obvious,and it was more predominant on the 6th day and the 7th day,which was 66.0%,77.1%(P<0.01)respectively,showing emergence of new non-susceptible pathogenic bacteria.With increase in the use of different antibiotics,the species of pathogenic bacteria showed to increase an increasing tendency of change.When Gram-negative bacillus infection was treated,antibiotic resistant bacteria such as Candida albicans and MRSA usually appeared.But when Gram.positive bacillus infections were treated,Candida albicans,Pseudomonas aeruginosa and Enterobacter cloacae readily appeared.There was relationship between the change in pathogenic bacteria and age,and the length of stay of the patients.The more older in age and the longer the length of stay,the change in pathogenic bacteria was more predominant.Conclusion New antibiotic resistant pathogenic bacteria appeares after seven-day antibiotic-targeted therapy in ICU.The change of species of pathogenic bacteria is related to the duration and type of using antibiotic,and also the age and length of stay.The longer time of use and the more different types of antibiotic used,the older in age and the longer in length of stay,the change in species of pathogenic bacteria is more predominant.Monitoring the dynamic change of pathogenic bacteria,adjusting the antibiotic promptly and rational use of antibiotics are very important to decrease the change in species and antibiotic resistance of the bacteria.
