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目的分析重症监护室(ICU)患者下呼吸道感染常见革兰阴性杆菌药物敏感性的变化趋势,为临床用药提供参考。方法对2005年1月~2007年12月在东莞市人民医院ICU送检的997份下呼吸道标本分离出的1102株病原菌分布及其常见革兰阴性菌(GNB)的体外药敏结果进行分析。结果2005、2006、2007所分离的病原体均以GNB为主,最常见的GNB为铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌和鲍曼不动杆菌;鲍曼不动杆菌和嗜麦芽窄食单胞菌分离率有上升趋势。3年间,铜绿假单胞菌对头孢他啶、亚胺培南、环丙沙星的耐药率上升(P<0.05),对环丙沙星耐药严重,大肠埃希菌、肺炎克雷伯菌对头孢他啶、头孢吡肟、环丙沙星耐药率上升,对亚胺培南具有高敏感率;鲍曼不动杆菌仅对亚胺培南保持较高敏感率。结论2005、2006、2007三年间GNB耐药率上升严重,因此对于ICU呼吸道感染患者治疗的抗菌药物选择应参照细菌和耐药性检测结果,以提高治疗成功率。
Objective To analyze the trend of the drug susceptibility of common Gram-negative bacilli in patients with lower respiratory tract infection in intensive care unit (ICU), and provide reference for clinical use. Methods The distribution of 1102 strains of pathogens isolated from 997 samples of lower respiratory tract in ICU of Dongguan People’s Hospital from January 2005 to December 2007 and the susceptibility of common gram-negative bacteria (GNB) in vitro were analyzed. Results The main pathogens isolated in 2005, 2006 and 2007 were GNB. The most common GNB were Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii; Acinetobacter baumannii and Stenotrophomonas maltophilia separation rate is on the rise. In the past three years, the resistance rate of Pseudomonas aeruginosa to ceftazidime, imipenem and ciprofloxacin increased (P <0.05), the drug resistance to ciprofloxacin, Escherichia coli, Klebsiella pneumoniae The resistance rates to ceftazidime, cefepime and ciprofloxacin increased, and the sensitivity to imipenem was high. Acinetobacter baumannii only maintained high sensitivity to imipenem. Conclusion The prevalence of GNB in three years increased significantly in 2005, 2006 and 2007, so the choice of antimicrobial agents should be based on the results of bacteria and drug resistance test in patients with ICU respiratory tract infection to improve the success rate of treatment.