航空航天医学杂志
航空航天醫學雜誌
항공항천의학잡지
AEROSPACE MEDICINE
2015年
4期
425-427
,共3页
梁结柱%罗胜%冼宙宁%黄金桔
樑結柱%囉勝%冼宙寧%黃金桔
량결주%라성%승주저%황금길
重症监护病房( ICU)%下呼吸道感染%病原菌%耐药
重癥鑑護病房( ICU)%下呼吸道感染%病原菌%耐藥
중증감호병방( ICU)%하호흡도감염%병원균%내약
intensive care units%lower airways infection%pathogens%antibiotic resistance
目的：探讨重症监护病房患者下呼吸道感染的病原菌分布和药物敏感性的特点，为临床选用抗菌药物提供参考。方法分析2012年6月～2013年6月ICU送检的呼吸道痰标本的细菌学鉴定和药物敏感性试验的结果。结果280份阳性标本中共检出致病菌株310株，其中革兰氏阴性杆菌225株（72．6％），分列前四位是铜绿假单胞菌，鲍曼不动杆菌，大肠埃希菌，肺炎克雷伯菌，革兰氏阳性菌58株（18．6％），主要是葡萄球菌和肠球菌；真菌27株占8．8％，主要是白色念珠菌，药敏结果显示：病原菌对常规的β－内酰胺类、氨基糖苷类和大环内酯类等抗菌药物严重耐药，鲍曼不动杆菌对碳青霉烯类泛耐药，未见有耐万古霉素金黄色葡萄球菌（ VR－SA）。结论呼吸道细菌的耐药情况越来越复杂，包括耐碳青霉烯类CRAB的增加和革兰氏阴性菌及阳性菌混合感染的增多，定期、系统地进行细菌的分布和耐药性检测分析，能规范抗生素的使用，减少耐药菌的产生，获得比较满意的疗效。
目的：探討重癥鑑護病房患者下呼吸道感染的病原菌分佈和藥物敏感性的特點，為臨床選用抗菌藥物提供參攷。方法分析2012年6月～2013年6月ICU送檢的呼吸道痰標本的細菌學鑒定和藥物敏感性試驗的結果。結果280份暘性標本中共檢齣緻病菌株310株，其中革蘭氏陰性桿菌225株（72．6％），分列前四位是銅綠假單胞菌，鮑曼不動桿菌，大腸埃希菌，肺炎剋雷伯菌，革蘭氏暘性菌58株（18．6％），主要是葡萄毬菌和腸毬菌；真菌27株佔8．8％，主要是白色唸珠菌，藥敏結果顯示：病原菌對常規的β－內酰胺類、氨基糖苷類和大環內酯類等抗菌藥物嚴重耐藥，鮑曼不動桿菌對碳青黴烯類汎耐藥，未見有耐萬古黴素金黃色葡萄毬菌（ VR－SA）。結論呼吸道細菌的耐藥情況越來越複雜，包括耐碳青黴烯類CRAB的增加和革蘭氏陰性菌及暘性菌混閤感染的增多，定期、繫統地進行細菌的分佈和耐藥性檢測分析，能規範抗生素的使用，減少耐藥菌的產生，穫得比較滿意的療效。
목적：탐토중증감호병방환자하호흡도감염적병원균분포화약물민감성적특점，위림상선용항균약물제공삼고。방법분석2012년6월～2013년6월ICU송검적호흡도담표본적세균학감정화약물민감성시험적결과。결과280빈양성표본중공검출치병균주310주，기중혁란씨음성간균225주（72．6％），분렬전사위시동록가단포균，포만불동간균，대장애희균，폐염극뢰백균，혁란씨양성균58주（18．6％），주요시포도구균화장구균；진균27주점8．8％，주요시백색념주균，약민결과현시：병원균대상규적β－내선알류、안기당감류화대배내지류등항균약물엄중내약，포만불동간균대탄청매희류범내약，미견유내만고매소금황색포도구균（ VR－SA）。결론호흡도세균적내약정황월래월복잡，포괄내탄청매희류CRAB적증가화혁란씨음성균급양성균혼합감염적증다，정기、계통지진행세균적분포화내약성검측분석，능규범항생소적사용，감소내약균적산생，획득비교만의적료효。
Objective To determine pathogens and drug resistance of lower respiratory tract infection in patientsre -ceiving mechanical ventilation in ICU and to provide the reference for clinical prevention and treatment .Methods The positive phlegm samples of ICU patients from Jun 2012 to Jun 2013 were analyzed by using retr ospectiv eanalysis .Both bacterial identification and drug susceptibility test .Results A total of 310 pathogens were detected from 280 sputum specimens,including 225 strains(72.6%)of Gram-negative bacilli,58 strains(18.6%)of Gram-positive bacilli and 27 strains(8.8%)of fungi.The most common Gram-negative bacilli were P.Aeruginosa, Acinetobacter baumannii , Es-cherichiacoli , and Klebsiella pneumonia .The most common Gram -positive bacilli were Stap hylococcus aureus and Staphylococcus .Fungi27 strains ( 8.8%) , Moniliaalbican mainly .The drug susceptibility test showed that pathogens were of severe antibiotic resistance to beta -lactams,aminoglycosides and macrolides , Acinetobacter baumannii was se-rious antibiotic resistance to carbopenems , and none of Stap hylococcus aureus was detected for antibiotic resistance to vancomycin.Conclusi ons With antibiotic resistance of pathogens in lower airways infection was performing more and more seriously ,especially with the increasing of CRAB and mixed infection of Gram -positive bacilli Pulmonary infections in ICU are mainly caused by Gram -negative and Gram-negat ive bacillus.So,satisfactoryefficacy can be achieved by drug sensitivity tests at regular intervals and resistance t rend analysis for guiding the use of antibiotics .
