重症监护室与非重症监护室住院患者医院获得性肺炎感染病原菌分布及耐药性分析

摘要

目的 比较重症监护室(ICU)与非ICU住院患者医院获得性肺炎(HAP)感染病原菌分布及耐药情况,为临床抗感染治疗进一步提供理论依据.方法 选取医院2014年1月至2017年1月ICU和非ICU HAP感染住院患者各168例,回顾性分析患者的临床资料,记录并分析所有患者所感染病原菌种类及占比和耐药情况.结果 共培养出病原菌336株,其中革兰阴性菌感染最常见(178株,占52.98％);ICU患者对革兰阴性菌中鲍曼不动杆菌和嗜麦芽寡养单胞菌感染率(17.86％和8.33％)明显高于非ICU患者(7.14％和1.19％);革兰阳性菌感染率在ICU和非ICU住院患者中无明显差异;非ICU患者的真菌感染率(34.52％)明显高于ICU患者(22.62％),其中白色假丝酵母菌感染率(17.86％)最高(P<0.05).几种主要革兰阴性菌中,ICU患者对鲍曼不动杆菌耐药率最高的为氨曲南(29株,96.67％),对肺炎克雷伯菌耐药率最高的为哌拉西林(6株,75.00％),非ICU患者对应的分别为哌拉西林(9株,75.00％),磺胺甲唑甲氧苄啶(18株,75.00％).革兰阳性菌对万古霉素、利奈唑胺或替考拉宁无耐药性;真菌中,感染率最高的白色假丝酵母菌对5-氟胞嘧啶、氟康唑等抗真菌药物敏感性均较好,耐药率均较低(小于20.00％).结论 ICU的HAP感染住院患者以革兰阴性菌感染为主,非ICU住院患者以真菌感染为主,且ICU的HAP感染住院患者对临床常规抗菌药物的耐药率明显高于非ICU的HAP感染住院患者.%Objective To compare the distribution and drug resistance of pathogens in hospital acquired pneumonia (HAP)in intensive care unit(ICU)inpatients and non intensive care unit (non-ICU)inpatients,and to provide further theoretical basis for clinical anti-infection treatment. Methods Totally 168 ICU inpatients and 168 non-ICU inpatients from January 2014 to January 2017 in our hos-pital were selected,and the clinical data of all patients were analyzed by retrospective analysis. The pathogens,its proportion and the drug resistance of all patients were recorded and analyzed. Results Totally 336 strains of pathogenic bacteria were cultured,among which gram negative bacteria were the most common (178 strains,accounting for 52. 98％). The infection rates of Acinetobacter bau-mannii and Stenotrophomonas maltophilia in gram negative bacteria in ICU patients (17. 86％ and 8. 33％) were significantly higher than those in non-ICU patients (7. 14％ and 1. 19％). There was no significant difference in the rate of gram positive infection in ICU inpatients and non-ICU inpatients. The rate of fungal infection in non-ICU patients(34. 52％)was significantly higher than that in ICU patients (22. 62％),and the rate of Candida albicans infection (17. 86％)was the highest (P < 0. 05). In the main gram negative bacteria ,the highest rate of resistance to Acinetobacter baumannii in ICU patients was aztreonam (29 strains,96. 67％),and the highest rate of resistance to Klebsiella pneumoniae was piperacillin (6 strains,75. 00％), while 9 strains of piperacillin (75. 00％) and 18 strains of sulfamethoxazole trimethoprim (75. 00％) in non-ICU patients. Gram positive bacteria were not resistant to van-comycin,linezolid or teicoplanin. Among the fungi,Candida albicans with the highest infection rate was sensitive to 5 - fluorine,cyto-sine,fluconazole and other antifungal agents,and their resistance rates were low (less than 20. 00％). Conclusion Inpatients with HAP infection in ICU was mainly caused by gram negative bacteria,while non-ICU inpatients were mainly infected with fungi,and the resis-tance rate to routine clinical antimicrobial drug of inpatients with HAP infection in ICU was significantly higher than that of inpatients with HAP infection in non-ICU.