2024 年第 7 期 第 0 卷

急诊重症患者下呼吸道感染常见病原菌分布及耐药性分析

Analysis of the distribution and drug resistance of common pathogens in critically ill patients with lower respiratory tract infection in emergency department

作者：孟倩姝1沈海涛2

英文作者：Meng Qianshu1 Shen Haitao2

单位：1中国医科大学附属盛京医院第二急诊科，沈阳110001；2中国医科大学附属盛京医院第三急诊科，沈阳110001

英文单位：1Second Department of Emergency Shengjing Hospital of China Medical University Shenyang 110001 China; 2Third Department of Emergency Shengjing Hospital of China Medical University Shenyang 110001 China

关键词：下呼吸道感染；急危重症；抗菌药物；耐药性

英文关键词：Lowerrespiratorytractinfection;Urgentandcriticalillness;Antibacterialdrugs;Drugresistance

• 摘要：

• 目的 分析急诊重症患者下呼吸道感染常见病原菌分布及耐药性。方法 通过中国医科大学附属盛京医院检验科实验室信息系统收集2017年1月至2018年12月急诊科送检的痰液、胸腔积液、肺灌洗液标本中细菌培养阳性的菌株，再通过本院电子病历以及影像系统软件筛选出符合纳入标准的共计432株菌株。分析菌群分布情况并通过药敏试验分析其耐药性。结果 432株菌株中革兰阴性杆菌411株，革兰阳性球菌19株，革兰阴性杆菌中以鲍曼不动杆菌为主（共172株、占总菌株数的39.81%），其次为铜绿假单胞菌（共97株、占总菌株数的22.45%）。鲍曼不动杆菌对阿米卡星和替加环素的敏感率可达80%以上。铜绿假单胞菌对阿米卡星、庆大霉素、头孢哌酮/舒巴坦、妥布霉素的敏感率均在80%以上。结论 在急诊重症下呼吸道感染患者致病菌中最常见的是鲍曼不动杆菌，其次是铜绿假单胞菌，鲍曼不动杆菌对阿米卡星以及替加环素敏感，可纳入经验性治疗。

• Objective To analyze the distribution and drug resistance of common pathogens in critically ill patients with lower respiratory tract infection in emergency department. Methods The bacterial culture-positive strains in sputum, pleural effusion and lung lavage fluid samples from the Department of Emergency, Shengjing Hospital of China Medical University from January 2017 to December 2018 were collected through the laboratory information system of the Department of Laboratory, Shengjing Hospital of China Medical University. A total of 432 strains that met the inclusion criteria were screened through the electronic medical record and imaging system software of our hospital. The distribution of bacteria was analyzed and the drug resistance was analyzed by drug sensitivity test. Results  Among the 432 strains, 411 were Gram negative bacteria and 19 were Gram positive cocci. Among the Gram negative bacteria, the main one was Acinetobacter baumannii(172 strains, accounting for 39.81% of the total bacterial strains), followed by Pseudomonas aeruginosa(97 strains, accounting for 22.45% of the total bacterial strains). Acinetobacter baumannii had a sensitivity rate of over 80% to amikacin and tigecycline. Pseudomonas aeruginosa had a sensitivity rate of over 80% to amikacin, gentamicin, cefoperazone/sulbactam, and tobramycin. Conclusion  Acinetobacter baumannii and Pseudomonas aeruginosa are the most common pathogenic bacteria in critically ill patients with lower respiratory tract infection in emergency department. Amikacin and tigecycline are sensitive to Acinetobacter baumannii which can be included in empirical treatment.