摘要
目的:探讨急诊重症监护室(EICU)肺炎痰细菌分离、药敏及临床危险因素,以指导临床应用抗菌药物。方法:回顾性分析2010年1月-2013年12月我院EICU诊治的590例肺炎患者的临床资料。结果:本组590例患者共分离病原菌493株,分离病原菌以革兰阴性菌为主,有393株,革兰阳性球菌70株,真菌30株;主要病原菌有大肠埃希氏菌、铜绿假单胞菌、肺炎克雷伯杆菌、鲍曼不动杆菌、凝固酶阴性葡萄球菌、金黄色葡萄球菌及真菌等。鲍曼不动杆菌对常用抗菌素耐药率达50%以上;多数革兰氏阴性杆菌对亚胺培南或美罗培南保持较高的敏感度,其次为β-内酰胺酶抑制剂;革兰氏阳性球菌(MRCNS/MRSA)对青霉素耐药率达90%左右,而对万古霉素、替考拉宁、利奈唑胺仍高度敏感;真菌对伏立康唑敏感。结论:革兰氏阴性菌为我院EICU的优势病原微生物,尤以大肠埃希氏菌最多,耐药菌产生率高;对于SCAP/HAP/VAP患者初始治疗应给予"重拳打击"降阶梯治疗。
Objective： To explore the pneumonia sputum bacteria, drug sensitivity and clinical risk factors in emergency intensive care unit （EICU） to guide the clinical application of antibacterial drugs. Methods： The clinical data of 590 patients with pneumonia in the EICU were retrospectively analyzed from Jan 2010 to Dec 2013. Results： Among the 590 cases, 493 strains of pathogenic bacteria were isolated. And gram negative bacteria were 393 strains, gram positive cocci were 70 strains and fungi were 30 strains. The main pathogenic bacteria were Eseherichia coli, Pseudomonasaeruginosa bacterium, Klebsiella pneumonia, Bauman Acinetobacter, coagulase negative staphylococci, Staphylococcus aureus and fungi. Bauman Acineto- baeter resistance rate to common antibiotics was more than 50%, most of gram negative bacilli to imipenem or meropenem maintained high sensitivity, followed by beta lactamase inhibitor, gram positive cocci （MRCNS/MRSA） of penicillin resistance rate of about 90%, but to vancomyein, linezolid, TiKaoLaing stilled highly sensitive, fungal sensitivity to Fushita Yasu. Conclusion： Gram negative bacteria in the EICU advantage of pathogenic microorganisms, especially in Escherichia coli, the emergence of drug-resistant strains rate is high; the initial treatment for patients with SCAP/HAP/VAP should be given ＂punch＂ deescalation therapy.
出处
《岭南急诊医学杂志》
2014年第4期266-268,共3页
Lingnan Journal of Emergency Medicine
关键词
急诊重症监护室
肺炎
细菌
耐药性
emergency intensive care unit
pneumonia
bacteria
drug resistance
