摘要
目的分析腹腔术后患者肺部感染各期病原菌分布及耐药特点,为临床选择抗菌药物提供参考。方法将2004年1月-2007年9月腹腔术后肺部感染病程长的45例患者病程分为初、中、后期,回顾性地分析各期痰及支气管肺泡灌洗液(BALF)标本细菌培养及药敏试验结果。结果共分离出病原菌189株,其中革兰阴性(G-)杆菌110株(58.2%),以铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌为主;革兰阳性(G+)球菌59株(31.2%),以金黄色葡萄球菌、屎肠球菌为主;真菌20株(10.6%),以白色假丝酵母菌为主;初期病原菌以G-菌为主,中期G+球菌明显增多,中、后期检出真菌,混合感染率高(64.4%),药敏结果显示,铜绿假单胞菌对多种抗菌药物耐药性增加,肠杆菌科细菌对碳青酶烯类抗菌药物耐药率为0,G+球菌对利奈唑胺、万古霉素耐药率为0。结论腹腔术后肺部感染的各期病原菌分布不同,感染菌株呈多药耐药,经验性选择抗菌药物时应针对上述特点,以期获得更好疗效。
OBJECTIVE To evaluate distribution and resistance of pathogens in patients with pulmonary infection after abdominal operation by stages, and provide reference to select antibiotics in clinics. METHODS Forty five patients with pulmonary infection after abdominal operation were included from Jan 2004 to Sep 2007. Their course was divided into 3 stages： onset stage, middle stage and last stage, at every stage to identify pathogens and to test drug sensitivity and the sputa and broncho-alveolar lavage fluid（BALF） were sampled. RESULTS A total of 189 strains of pathogens were isolated, from them 110（58.2%）were Gram-negative bacilli including Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae; and 59 （31.2%）were Gram-positive cocci including Staphylococcus aureus and Enterococcus; and 20（10.6%）were fungi, Candida albicans was the main fungus. At onset stage the most pathogens were Gram-negative bacilli; at middle stage the Gram-positive cocci increased distinctly; and the fungi were detected at middle and last stages. The mixed infection rate was high. The result of drug sensitive test showed that there were high rates of multidrug resistance in P. aeruginosa. The resistance rates of all isolates of Enterobacteriaceae to imipenem or meropenem were 0. The resistance rates of all Gram-positive cocci to linezolid or vancomycin were 0. CONCLUSIONS Distribution of pathogens in patients with pulmonary infection after abdominal operation is different at each stage. The most are multidrug resistant, and rationl use of antibacterial drug in clinics must be based on the distribution and drug-resistance of pathogens.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2008年第8期1189-1191,共3页
Chinese Journal of Nosocomiology
关键词
肺部感染
腹腔手术
病原菌
耐药性
Pulmonary infection
Abdominal operation
Pathogen
Drug-resistance
