ICU院内肺部感染细菌研究及超广谱β-内酰胺酶(ESBL)细菌抗生素敏感性探究.doc

ICU院内肺部感染细菌研究及超广谱β-内酰胺酶(ESBL)细菌抗生素敏感性探究[摘要] 目的：探讨ICU院内肺部感染病原菌特点及ESBL细菌对抗生素的敏感性。方法：285份呼吸道分泌物标本采用梅里埃VITEK自动生物分析仪进行细菌鉴定，采用纸片扩散法和双纸片协同实验进行药敏实验和ESBL检测。结果：院内肺部感染发生率为26.1%，产ESBL发生率为42.4%，病原菌细菌培养结果显示G+菌中以金黄色葡萄球菌为最，Gˉ菌中铜绿假单胞菌为最；G+菌主要对万古霉素、利福平和头孢西丁敏感，Gˉ菌对大部分药物耐药，相对敏感的药物主要为头霉素类的药物头孢西丁、单环类的药物氨曲南、亚胺培南、亚胺硫霉素和加了酶抑制剂他唑巴坦的氧哌嗪青霉素。结论：重视医院内感染的监测，合理使用超广谱β-内酰胺酶抗生素，对患者采取有效的保护性措施，可防止和治疗院内感染。 [关键词] 重症监护病房；医院内感染；超广谱β-内酰胺酶；细菌敏感性 [中图分类号]R563 [文献标识码]A [文章编号]1673-7210（2007）09（c）-015-04 Bacterium analysis of pulmonary infection in hospital intensive care unit and antibiotic sensitivity research of extended spectrum β-lactamases LING Yun, YE Chu-yang, HE Song-bin, GONG Xiao-qi (Department of ICU, Huizhou Centre People’s Hospital ,Huizhou 516001,China) [Abstract] Objective: To investigate the characteristics of pulmonary infection in hospital and bacterial antibiotic sensitivity of the ESBL. Methods: 285 clinical samples were identified by VITEK system, and tested by diffusion method and double face method in drug sensitive experiment and ESBL detection．Results: Hospital infection rate was about 26.1％, The ESBL bacterium was about 42.4％. Bacterial cultures showed that gram positive bacterium was most of staphylococcus aurous, and gram negative bacterium was most of pseudomonas aeruginosa. the gram positive bacterium was sensitive to vancomycin、rifampicin and cefoxitin, gram negative bacterium was resistant to most of drug, but relative sensitively to cefoxitin、aztreonam、imipenem and piperacillin added with enzyme inhibitor. Conclusion: It is important to value hospital infection, and use the ESBL antibiotics rationally to protect patient benefit and cure and prevent the hospital infection． [Key words] Intensive care unit; Hospital infection; Extended spectrum β-lactamases(ESBL); Antimicrobial susceptibility ICU院内感染发生率比普通病房高，其中又以肺部感染为多见,而细菌耐药性的出现是影响病人预后的主要原因。细菌耐药与抗生素的使用有关。研究表明，抗菌药物选择压力可诱导细菌产生耐药菌株，也可以解释为这种耐药是被诱导出来的，例如，当暴露于某些抗生素时，细菌可通过启动ampR而促使ampC合成AmpC酶，从而产生耐药性。因此，在临床上，应尽量不使