摘要
目的分析南京市江宁医院下呼吸道感染门诊及住院患者痰样本病原体分布情况和耐药特点,为临床进一步合理用药提供可靠依据。方法收集2011-2015年南京市江宁医院门诊及住院下呼吸道感染患者痰样本,常规方法进行病原体分离,采用Vitek2-Compact全自动细菌鉴定及药敏分析系统对培养得到的纯培养物进行细菌鉴定和药敏试验,对系统不能进行药敏试验的药物采用纸片扩散法(K-B法),真菌药敏试验采用ATB FUGUNS 3试条(微量稀释法)进行。结果从2011-2015年的13 147例下呼吸道感染门诊及住院患者的痰样本中共分离出病原体4 791株,阳性检出率为36.44%。其中革兰阴性杆菌占71.34%,排列前4位的分别为肺炎克雷伯菌(19.70%)、铜绿假单胞菌(15.26%)、鲍曼不动杆菌(12.04%)和大肠埃希菌(10.17%);革兰阳性球菌占17.83%,主要为金黄色葡萄球菌(7.43%)、肠球菌(6.45%)和肺炎链球菌(3.17%);真菌占10.83%,主要为白假丝酵母菌(4.26%)、热带假丝酵母菌(3.32%)和光滑假丝酵母菌(2.50%)。药敏试验结果显示,5年间肺炎克雷伯菌对美罗培南和亚胺培南耐药率最低,分别为0%和0.21%,其次为对头孢哌酮/舒巴坦和哌拉西林/他唑巴坦的耐药率,分别为4.24%和4.87%;铜绿假单胞菌对阿米卡星、头孢吡肟、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦的耐药率较低,分别为9.17%,14.09%、12.72%和8.34%,未检出对多黏菌素B耐药株;鲍曼不动杆菌对米诺环素和头孢哌酮/舒巴坦的耐药率较低,分别为12.13%和13.86%;未检出对美罗培南和亚胺培南耐药的大肠埃希菌,对头孢哌酮/舒巴坦和哌拉西林/他唑巴坦的耐药率较低,分别为4.72%和6.78%;未检出对利奈唑胺、万古霉素和替考拉宁耐药的金黄色葡萄球和肠球菌,未检出对青霉素、利奈唑胺和万古霉素耐药的肺炎链球菌;未检出对氟胞嘧啶和两性霉素B耐药的念珠菌属。结论下呼吸道感染病原体种类多,耐药情况比较严重,临床应合理使用抗菌药物,避免耐多药菌株的出现。
Objective To analyze the distribution and drug resistance of pathogens in lower respiratory tract infection so as to provide a reliable reference for antibiotics use. Methods The sputum specimens of patients with lower airway infection were collected in Jiangning Hospital from 2011-2015 and were cultured with conventional methods.Pathogen identification drug susceptibility test were performed using Vitek2-Compact system and K-B method.The drug susceptibility test for fungus were performed using ATB FUNGUS 3（microdilution method）. Results A total of 4 791 bacteria strains were isolated from sputum sample collected from13 147 cases with lower airway infection in 2011-2015,the detection rate of pathogenic bacteria was 36.44%.Majority（71.34%）were Gram-negative bacilli and the top four K.pneumoniae（19.70%）,P.aeruginosa（15.26%）,A.baumannii（12.04%）,and E.coli（10.17%）.17.83% were Gram-positive coccus,S.aureus（7.43%）,Enterococcus（6.45%）and S.pneumoniae（3.17%）were common ones.10.83% pathogens were fungi,C.albican（4.26%）,C.pseudotropicalis（3.32%）and C.glabrata（2.50%）were predominant.The drug sensitivity test revealed that K.pneumoniae had the lowest drug resistance rates of 0% and 0.21% to Meropenem and Imipenem in 5year period.and the drug resistance rates to Cefoperazone/sulbactam and Piperacillin/Tazobactam were 4.24% and 4.87%.The drug resistance rates of P.aeruginosa to Amikacin,Cefepime,Piperacillin/Tazobactam and Cefoperazone/sulbactam were the lowest of 9.17%,14.09%,12.72% and 8.34%,respectively,no strains were resistant to Polymyxin B.The drug resistance of A.baumannii to Minocycline and Cefoperazone/sulbactam were the lowest of 12.13% and 13.86%.No strains of E.Coli were found to be resistant to Imipenem/M.eropenem,and the resistance rates to Cefoperazone/sulbactam and Piperacillin/Tazobactam were also low of 4.72%and 6.78%.No stains of S.aureus and Enterococcus were found to be resistant to Linezolid,Vancomycin and Teicoplanin,no strains of S.pneumoniae were found to be resistant to Penicillin,Linezolid and Vancomycin,and no strains of Mycocandida were resistant to Flucytosine and Amphotericin B. Conclusions Many different kinds of pathogens are identified in the sputum samples of patients with lower airway infection and majority of them are highly resistant to drugs.Therefore,antibiotics should be used properly in clinics to avoid the emerging of multi-drug resistant strains.
出处
《中国预防医学杂志》
CAS
2016年第8期605-611,共7页
Chinese Preventive Medicine
关键词
下呼吸道感染
病原体
耐药性
Lower respiratory tract infection
Pathogenic bacteria
Drug resistance
