龙岗区ICU患者下呼吸道感染非发酵菌的病原菌分布、耐药性和金属酶分析(1)
【摘要】 目的：分析重症监护病房(intensive care unit，ICU)下呼吸道感染中非发酵菌的菌群分布、耐药以及金属酶情况，为临床抗菌药物的合理使用提供指导。方法：选取深圳市龙岗中心医院于2016年1月-2017年12月收治的100例下呼吸道感染患者为研究对象，根据患者送检标本的检出结果对非发酵菌的病原菌群分布、耐药性和金属酶进行分析。结果：100例ICU下呼吸道感染患者中，非发酵菌感染比例最高的为鲍曼不动杆菌47株(47.0%)，其次是铜绿假单胞菌29株(29.0%)，嗜麦芽窄食单胞菌9株(9.0%)，其他非发酵菌15株(15.0%)。鲍曼不动杆菌对头孢吡肟、头孢他啶、氨苄西林/舒巴坦、亚胺培南、氨曲南耐药率均在80.0%以上。铜绿假单胞菌耐药性发生率相对较低，其中对头孢吡肟、左氧氟沙星的耐药率均在50.0%以上。嗜麦芽窄食单胞菌对复方新诺明、左氧氟沙星的耐藥率均在20.0%以下。29株铜绿假单胞菌中共筛检出3株(10.3%)金属酶阳性株。结论：下呼吸道感染非发酵菌以鲍曼不动杆菌、铜绿假单胞菌较为常见，对不同抗菌药物具有较高耐药性，临床上应针对性地加强对各种病原菌的监控，指导抗菌药物的合理使用，避免或者减少耐药现象的发生。
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【关键词】 ICU； 下呼吸道； 感染； 非发酵菌； 耐药性
【Abstract】 Objective：To analyze the pathogen distribution，drug resistance and metallozyme of non-fermentative bacteria in ICU patients with lower respiratory tract infection，and to provide guidance for rational use of clinical antimicrobial agents.Method：A total of 100 patients with lower respiratory tract infection admitted in Longgang Central Hospital of Shenzhen from January 2016 to December 2017 were selected as study objects.According to the result of the patient’s specimen，the pathogen distribution，drug resistance and metallozyme of non-fermentative bacteria were analyzed.Result：Among 100 patients with lower respiratory tract infection in ICU，the infection rate of acinetobacter baumannii was the most with 47 strains (47.0%)，the next were pseudomonas aeruginosa 29 strains(29.0%)，stenotrophomonas maltophilia 9 strains (9.0%) and the other non-fermentative bacteria 15 strains (15.0%).The resistance rates of acinetobacter baumannii to Cefepime，Ceftazidime，Ampicillin/Shubatan，Imipenem，Aztreonam were above 80.0%，the pseudomonas aeruginosa to Cefepime，Levofloxacin were all over 50.0% and stenotrophomonas maltophilia to Compound Sulfamethoxazole and Levofloxacin were below 20.0%.3 metallozyme positive strains (10.3%) were detected in 29 strains pseudomonas aeruginosa.Conclusion： Acinetobacter baumannii and pseudomonas aeruginosa are the most common non-fermentative bacteria of lower respiratory tract infection，all of which have high resistance to different antimicrobial agents.The clinical monitoring of various pathogens should be strengthened to guide the rational use of antimicrobial agents and to avoid or reduce the occurrence of drug resistance.
【Key words】 Intensive care unit； Lower respiratory tract； Infection； Non-fermentative bacteria； Drug resistance
First-author’s address：Longgang Central Hospital of Shenzhen，Shenzhen 518116，China
doi：10.3969/j.issn.1674-4985.2018.18.039, 百拇医药(黄翠兰 郭光辉 彭卉 杨阳)
, http://www.100md.com
【关键词】 ICU； 下呼吸道； 感染； 非发酵菌； 耐药性
【Abstract】 Objective：To analyze the pathogen distribution，drug resistance and metallozyme of non-fermentative bacteria in ICU patients with lower respiratory tract infection，and to provide guidance for rational use of clinical antimicrobial agents.Method：A total of 100 patients with lower respiratory tract infection admitted in Longgang Central Hospital of Shenzhen from January 2016 to December 2017 were selected as study objects.According to the result of the patient’s specimen，the pathogen distribution，drug resistance and metallozyme of non-fermentative bacteria were analyzed.Result：Among 100 patients with lower respiratory tract infection in ICU，the infection rate of acinetobacter baumannii was the most with 47 strains (47.0%)，the next were pseudomonas aeruginosa 29 strains(29.0%)，stenotrophomonas maltophilia 9 strains (9.0%) and the other non-fermentative bacteria 15 strains (15.0%).The resistance rates of acinetobacter baumannii to Cefepime，Ceftazidime，Ampicillin/Shubatan，Imipenem，Aztreonam were above 80.0%，the pseudomonas aeruginosa to Cefepime，Levofloxacin were all over 50.0% and stenotrophomonas maltophilia to Compound Sulfamethoxazole and Levofloxacin were below 20.0%.3 metallozyme positive strains (10.3%) were detected in 29 strains pseudomonas aeruginosa.Conclusion： Acinetobacter baumannii and pseudomonas aeruginosa are the most common non-fermentative bacteria of lower respiratory tract infection，all of which have high resistance to different antimicrobial agents.The clinical monitoring of various pathogens should be strengthened to guide the rational use of antimicrobial agents and to avoid or reduce the occurrence of drug resistance.
【Key words】 Intensive care unit； Lower respiratory tract； Infection； Non-fermentative bacteria； Drug resistance
First-author’s address：Longgang Central Hospital of Shenzhen，Shenzhen 518116，China
doi：10.3969/j.issn.1674-4985.2018.18.039, 百拇医药(黄翠兰 郭光辉 彭卉 杨阳)