摘要
目的了解不同临床科室下呼吸道感染病原菌的基本构成及优势菌的耐药性。方法对2008年1—5月住院的下呼吸道感染患者下呼吸道标本进行培养，用VITEK细菌鉴定及药敏分析系统对菌落进行菌种鉴定及药敏分析，对检出菌株的临床分布特点及优势菌的药敏结果进行分析。结果共检出502株病原菌，其中革兰阴性杆菌340株（67．7％）、革兰阳性球菌32株（6．4％）、真菌130株（25．9％）；在372株细菌中，鲍氏不动杆菌（21．5％）、铜绿假单胞菌（16．9％）、肺炎克雷伯菌（14．8％）、大肠埃希菌（12．4％）为前4位优势菌种；非发酵菌主要分布在重症监护病房（ICU）与临床外科，而肠杆菌科细菌及真菌则主要分布在非手术科室中；4位优势菌种的药敏结果中，鲍氏不动杆菌对亚胺培南、美罗培南的耐药率分别为7．5％、8．8％，而对其他抗菌药物的耐药率较高，分别为53．8％～100．0％；铜绿假单胞菌对亚胺培南、美罗培南、多黏菌素E、环丙沙星、阿米卡星、妥布霉素、庆大霉素的耐药率分别为11．1％～27．0％，对青霉素类、头孢菌素类及含β-内酰胺酶抑制剂复合剂等其他抗菌药物的耐药率则为38．1％～100．0％；大肠埃希菌产ESBLs率（71．7％）高于肺炎克雷伯菌的产酶率（29．1％），均对美罗培南、亚胺培南敏感，除对阿米卡星的耐药率两者均为10．9％外，对于其他的抗菌药物，大肠埃希菌的耐药性普遍较肺炎克雷伯菌严重。结论非发酵菌主要集中在ICU及手术科室，而肠杆菌科细菌和真菌则主要集中在非手术科室；病原菌的耐药性多呈交叉耐药，仅对亚胺培南、美罗培南、阿米卡星等极少数抗菌药物敏感性较好，因此，临床应加强预防医院感染发生的措施，一旦发生则应根据药物敏感性报告合理用药。
OBJECTIVE To investigate the characteristic of clinical distribution and drug resistance of pathogenic bacteria in lower respiratory tract infection. METHODS Bacterial culture of the lower respiratory tract samples collected from patients who were admitted from Jan to May 2008 was done. The bacteria identification and drug sensitivity tests were done by VITEK bacterium identifying and drug sensitivity analyzing system. RESULTS A total of 502 pathogens were isolated, in which 340 strains of Gram-negative bacteria（67.7%）, 32 strains of Gram-positive cocci（6.4 %）and 130 strains of fungi（25.9 % ）. Of all the 372 strains of bacteria, the most common pathogens in turn were Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli, respectively. Non-fermenters were the dominant pathogens in intensive care unit （ICU）and the surgery wards, Enterobaeteriaceae and fungi were the dominant pathogens in the non-operation wards. Of A. baumannii strains, the antibiotic resistant rates to imipenem and meropenem were 7. 5% and 8.8%, respectively, the resistant rates to the other antibiotics were high（53.8%-100.0%, respectively）. Of P. aeruginosa strains, the antibiotic resistant rates to imipenem, meropenem, polymyxien E, ciprofloxaein, amikacin, tobramycin and gentamicin were 11.1 -27.0%, respectively, The resistant rates to the other antibiotics such as penicillins, cephalosporins and the complex antibiotics containing β-laetamases inhibitor were 38. 1%- 100. 0%. The ESBLs-producing rate of K. pneumoniae strains（71.7%）was higher than that of E. coli strains（29.1%）. K. pneumoniae strains and E. coli strains were all sensitive to imipenem and meropenem, and both of their resistant rates against amikacin were the same（10.9%）, but against the other antibiotics the resistance of E. coli strains were more serious than that of K. pneumoniae strains. CONCLUSIONS In our area, non-fermenters are mainly isolated from ICU and the surgery wards. Enterobacteriaeeae and fungi are mainly isolated from the non-operation wards. The major pathogens show multi-drug resistance except imipenem, meropenem and amikacin. It＇s important to prevent hospital acquired lower respiratory tract infection during the clinical therapy, and it is urgent for rational use of antimicrobial agents according to the results of antibiotics susceptibility tests.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2009年第11期1431-1434,共4页
Chinese Journal of Nosocomiology
关键词
下呼吸道感染
病原菌
临床分布特点
耐药性
Lower respiratory tract infection
Pathogen
Characteristic of clinical distribution
Drug resistance
