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重症监护病房患者下呼吸道分离出的革兰氏阴性杆菌的抗菌药物耐药性变化趋势:一项为期5年的研究。

Changing trend of antimicrobial resistance among gram-negative bacilli isolated from lower respiratory tract of ICU patients: A 5-year study.

作者信息

Gagneja Deep, Goel Nidhi, Aggarwal Ritu, Chaudhary Uma

机构信息

Department of Microbiology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, India.

出版信息

Indian J Crit Care Med. 2011 Jul;15(3):164-7. doi: 10.4103/0972-5229.84900.

Abstract

BACKGROUND

Lower respiratory tract infections (LRTIs) are the most frequent infections among patients in intensive care units (ICUs).

AIM

To track the resistance rate among the causative agents causing LRTI in the ICU patients.

DESIGN AND SETTINGS

This is a retrospective study done in a tertiary care hospital.

MATERIALS AND METHODS

Transtracheal or bronchial aspirates from 2776 patients admitted to the ICU were cultured and identified, and antibiotic sensitivity was performed by standard methods.

RESULTS

Of 2776 specimens, 1233 (44.41%) isolates were recovered, of which 1123 (91.07%) were gram-negative bacilli (GNB) and 110 (8.92%) were gram-positive organisms. From 2004 to 2009, Pseudomonas aeruginosa remained the most common pathogen. In phase I, high level of resistance (79-98%) was observed against all GNB. During phase II increasing trend in resistance to cephalosporins and declining trend in resistance to aminoglycosides against most GNB were observed. Multidrug resistance (resistance to three or more than three drugs) was observed in 83% of total isolates.

CONCLUSIONS

Gram-negative organisms are the predominant pathogens causing LRTI in ICU. The increasing trend of resistance to cephalosporins and carbapenems in gram-negative organisms is very disturbing. Judicious use of antimicrobial agents is essential to prevent the emergence of multidrug-resistant bacteria in the ICU.

摘要

背景

下呼吸道感染(LRTIs)是重症监护病房(ICUs)患者中最常见的感染。

目的

追踪重症监护病房患者下呼吸道感染病原体的耐药率。

设计与环境

这是一项在三级护理医院进行的回顾性研究。

材料与方法

对入住重症监护病房的2776例患者的经气管或支气管吸出物进行培养和鉴定,并采用标准方法进行药敏试验。

结果

在2776份标本中,分离出1233株(44.41%),其中1123株(91.07%)为革兰氏阴性杆菌(GNB),110株(8.92%)为革兰氏阳性菌。2004年至2009年,铜绿假单胞菌仍是最常见的病原体。在第一阶段,观察到所有革兰氏阴性杆菌的高水平耐药(79-98%)。在第二阶段,观察到大多数革兰氏阴性杆菌对头孢菌素的耐药性呈上升趋势,对氨基糖苷类的耐药性呈下降趋势。在所有分离株中,83%观察到多重耐药(对三种或三种以上药物耐药)。

结论

革兰氏阴性菌是重症监护病房引起下呼吸道感染的主要病原体。革兰氏阴性菌对头孢菌素和碳青霉烯类耐药性的上升趋势非常令人担忧。合理使用抗菌药物对于预防重症监护病房多重耐药菌的出现至关重要。

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