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目的探讨ICU重症脑疝患者肺部感染病原学特征以及复杂的耐药机制,为临床合理使用抗菌药物提供有利的治疗依据。方法收集2014年1月-2015年12月临床ICU重症脑疝住院患者的各类感染标本,采用常规方法培养分离细菌,用VITEK-32微生物分析系统进行病原菌鉴定,超广谱β-内酰胺酶(ESBLs)检测应用双纸片确认法,药敏试验采用K-B纸片扩散法,按CLSI规定的标准操作及判断结果进行。结果检出的主要病原菌为肺炎克雷伯菌326株占42.6%,大肠埃希菌87株占11.4%,金黄色葡萄球菌120株占15.7%;肺炎克雷伯菌对氨苄西林、哌拉西林的耐药率分别为100%和83.4%,而对亚胺培南、美罗培南的耐药率均为2.1%;大肠埃希菌对氨苄西林、哌拉西林、头孢噻肟钠等的耐药率均>51.7%,而对亚胺培南、美罗培南的耐药率为1.1%、0.0%;肺炎克雷伯菌产ESBLs 325株,检出率为27.4%,大肠埃希菌产ESBLs 86株,检出率为25.6%;金黄色葡萄球菌对青霉素、红霉素的耐药率分别为98.3%、84.2%。结论 ICU重症脑疝患者肺部感染病原菌对多种抗菌药物普遍存在较高的耐药性,医院应根据细菌鉴定和药敏检测结果选择性合理使用抗菌药物,以便有效地预控和减少耐药菌株的发生。
Objective To explore the etiological characteristics of pulmonary infection in patients with severe herniation in ICU and its complicated mechanism of drug resistance and to provide a favorable basis for the rational use of antimicrobial agents in clinical practice. Methods All kinds of infected inpatients with severe herniation from January 2014 to December 2015 in our hospital were collected. Bacteria were isolated and cultured by routine methods. The pathogenic bacteria were identified by VITEK-32 microbial analysis system, and extended-spectrum β-lactamases (ESBLs) test using double-disc confirmation method, susceptibility testing using KB disk diffusion method, according to CLSI standard operation and determine the results. Results The main pathogens detected were Klebsiella pneumoniae 326 (42.6%), Escherichia coli 87 (11.4%) and Staphylococcus aureus 120 (15.7%). Klebsiella pneumoniae was resistant to ampicillin, piperacillin Resistant rate was 100% and 83.4% respectively, but the resistance rates to imipenem and meropenem were both 2.1%. Escherichia coli was resistant to ampicillin, piperacillin and cefotaxime sodium The rates of resistance to imipenem and meropenem were 1.1% and 0.0%, respectively. There were 325 strains of ESBLs producing Klebsiella pneumoniae with the detection rate of 27.4% and ESBLs producing strains of Escherichia coli Strain, the detection rate was 25.6%; Staphylococcus aureus penicillin, erythromycin resistance rates were 98.3%, 84.2%. Conclusions The pathogen of pulmonary infection in severe herniation patients in ICU generally has high resistance to various antimicrobial agents. The hospital should selectively and reasonably use antimicrobial agents based on the results of bacterial identification and susceptibility testing in order to effectively control and reduce drug resistance The occurrence of strains.