Study The Pathogens Distribution And Drug Resistance Situation Of Patients With Lower Respiratory Tract Infection In Comprehensive Intensive Care Unit

Objective： To study the pathogens distribution and drug resistancesituation of patients with lower respiratory tract infection in our comprehensiveintensive care unit during2011to2013，provide a reference for the choice ofantibiotics.Methods: This research collects patients who were diagnosed as lowerrespiratory tract infection in our hospital comprehensive intensive care unitduring November2011to February2013，takes the pathogen isolation ofsputum samples, and analysises the distribution, composition ratio and sensitivetest. The categorical data were analyzed adopting Excel software and therelative numbers were expressed with rate and percentage.Results: The total cases of patients our hospital CICU received fromNovember2011to February2013was644. And198cases of them werediagnosised with lower respiratory tract infection. Infection rate was30.74%(198/664).Total inspection rate was57.6%(114/198),178sputum samples, anddetection ratio was47.15%(132/178).A total of167strains of pathogenicbacteria were isolated, including119strains (71.25%) of gram-negativebacterium. To the G-bacterium, the drug resistance rate of ampicillin was100%,and high resistant rate to cefazolin, Ampicillin/Sulbactam, cefuroxime sodium,cefotaxime, respectively was82.5%(28/34),82.35%(56/68),78.57%(44/56),71.30%(77/108), having the highest sensitivity to Piperacillin/Tazobactam,was78.38%(58/74), sensitivity were64.81%(70/108),61.74%(21/34) toamikacin, gatifloxacin, to imipenem the sensitivity rate is only57.41%(62/108). Gram negative bacilli mainly included41strains of pseudomonasaeruginosa (34.45%),34strains of acinetobacter baumannii (28.57%),20strains of Klebsiella pneumoniae (16.80%). To pseudomonas aeruginosa, the drug resistance rate of cefuroxime was100%and minocycline91.67%, havinghigh sensitivity rate to amikacin, tobramycin, specific for87.50%(35/40),90.00%(36/40) respectively. To acinetobacter baumannii, the drug resistancerate of cefuroxime was100%, and96.97%（32/33）to ceftazidime, ciprofloxacin,cefotaxime, cefepime, Gentamicin, piperacillin, ampicillin/sulbactam,compound sulfamethoxazole, cefpirome, having high sensitivity rate tominocycline, specific for80.77%(21/26). To klebsiella pneumoniae, the drugresistance rate of ampicillin and cefatrizine was100%, to piperacillin was80%(16/20), to cefazolin, cefotaxime, cefepime were all75%(15/20), the drugsensitivity to piperacillin/Tazobactam was100%,to cefoperazone/sulbactamand amikacin were95%(19/20),to ticarcillin/Clavulanic acid was90%(18/20).ESBLs-producing klebsiella pneumoniae were10strains, Enzyme productionrate was50%(10/20). According to the drug susceptibility test results, excepttobramycin and ticarcillin/clavulanic acid, the drug resistance rate of enzymeproduction strains was generally on the high side. Especially for cefuroxime,cefotaxime, cefepime, cefazolin, the drug resistance rate of EBSLs (+)klebsiella pneumoniae strain was more than EBSLs (-) strain by50%above.We found a total of four EBSLs (+) klebsiella strains for imipenem drugresistance. Gram positive bacteria were16strains (9.58%). All were grampositive coccus, and were sensitive to vancomycin, linezolid, resistance toampicillin, penicillin G. The staphylococcus aureus were14cases (87.5%),methicillin-resistant staphylococcus aureus were12cases, accounting for85.71%(12/14) of staphylococcus aureus. Hemolysis staphylococcus aureusand streptococcus pneumoniae each were only1case. Fungi were a total of32strains (18.93%), Mainly contained candida albicans19stains(59.38%) andcandida glabrata6stains(18.75%).Conclusions: in patients with lower respiratory tract infection of CICU,gram negative bacilli is still the main infection pathogens. We do not recommend using the first and second generation cephalosporins in thetreatment. And because the sensitivity to piperacillin-tazobactam was thehighest, to amikacin, gatifloxacin was higher, they can be used for empiricaltreatment. We can choose vancomycin, linezolid to cure gram-positive cocciinfection patients in ICU. Pathogen resistance monitoring should be regular tounderstand the distribution of pathogens in patients and drug resistance ofpathogenic bacteria. According to the characteristics of the local pathogens fortreatment is of great significance for clinical treatment and reducing thebroadcast popular of multiple drug-resistant bacteria.