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目的了解我院呼吸病房非发酵革兰阴性杆菌所致医院获得性肺炎的现状及其耐药性,为临床医生治疗感染性疾病抗菌素的选择提供依据。方法细菌鉴定采用常规方法,API系统补充鉴定,药敏试验采用纸片扩散法,临床资料采用回顾性分析。结果非发酵革兰阴性杆菌分离率62%,其中铜绿假单胞菌35.8%,不动杆菌12.8%,嗜麦芽窄食单胞菌6.9%,洋葱假单胞菌6.4%。临床资料显示高龄,有严重的基础疾病,免疫功能受损,机械通气,曾应用过广谱抗菌素是非发酵革兰阴性杆菌定植的危险因素。药敏试验显示,本组细菌对头孢菌素耐药率极高,对加酶抑制剂复方制剂、亚胺培南、丁胺卡那、头孢他啶、环丙沙星耐药率较低。结论非发酵革兰阴性杆菌是院内获得性肺炎的主要致病菌群,其耐药率高、难治性强,建立系统防范措施,合理应用抗生素,控制高危因素是降低其感染发生的重要因素。
Objective To understand the current status and drug resistance of hospital-acquired pneumonia caused by non-fermentative gram-negative bacilli in respiratory ward of our hospital and provide basis for selection of antibiotics by clinicians for treating infectious diseases. Methods Bacterial identification was performed by routine methods and API system. The susceptibility test was performed by disk diffusion method. The clinical data were retrospectively analyzed. Results The rate of non-fermentative gram-negative bacilli was 62%, of which 35.8% were Pseudomonas aeruginosa, 12.8% Acinetobacter, 6.9% Stenotrophomonas maltophilia and 6.4% Pseudomonas cepacia. Clinical data show that elderly, severe underlying diseases, impaired immune function, mechanical ventilation, have been used broad-spectrum antibiotics are non-fermentable Gram-negative bacteria colonization risk factors. Drug susceptibility tests showed that the group of bacteria resistant to cephalosporins extremely high rate of enzyme inhibitors on the compound, imipenem, amikacin, ceftazidime, ciprofloxacin resistance rate is low. Conclusion Non-fermentative gram-negative bacilli is the main pathogenic group of nosocomial pneumonia. It has high drug resistance and strong refractory. It is necessary to establish systematic preventive measures, reasonably use antibiotics and control high risk factors to reduce the incidence of infections .