呼吸内科病房病原菌分布及耐药性分析

目的分析呼吸内科病房病原菌的分布特点及其对常用抗菌药物的敏感性和耐药性。方法从2004—2006年我院呼吸内科病房送检痰标本中分离致病菌1599株,采用纸片扩散法(Kirby-Bauer法),按美国临床实验室标准委员会(NCCLS)标准判定敏感菌株并做药敏分析。结果常见病原菌为肺炎链球菌(28.3%)、铜绿假单胞杆菌(9.3%)、鲍曼不动杆菌(7.8%)、大肠杆菌(3.5%)、凝固酶阴性的葡萄球菌(6.4%)及金黄色葡萄球菌(1.4%)。药敏结果:肺炎链球菌、铜绿假单胞杆菌、鲍曼不动杆菌和大肠杆菌对氨苄西林、复方磺胺甲唑的耐药率均达100%,大肠杆菌和肺炎克雷伯杆菌对亚胺培南的敏感率为100%,鲍曼不动杆菌对亚胺培南的敏感率在86.7%以上。铜绿假单胞杆菌对所有的常用抗生素有不同程度耐药,其中对阿米卡星的敏感率在76.2%以上,其次为亚胺培南及美洛培南,敏感率在30%以上。肺炎链球菌、金黄色葡萄球菌及凝固酶阴性的葡萄球菌对青霉素的耐药率达100%,对万古霉素的敏感率达100%。结论革兰阴性杆菌是呼吸内科病房内感染的主要致病菌,细菌耐药问题日益严重,为控制耐药菌株的产生和扩散,抗生素的合理使用和细菌耐药性的监测尤为重要。

Prevalence of pathogenic bacteria and drug resistance in wards of respiratory diseases

Objective To analyze the distribution characteristics,antimicrobial sensitivity and resistance of bacterial isolates from wards of respiratory diseases.Methods Between 2004 and 2006,1599 strains of pathogenic bacteria were isolated from sputum specimens collected in our wards of respiratory diseases.These strains were assessed for antibiotic susceptibility using Kirby-Bauer method according to NCCLS standards.Results The prevalent pathogens in wards of respiratory diseases included Streptococcus pneumoniae(28.3%),Pseudomonas aeruginosa(9.3%),Acinetobacter baumanni(7.8%),Escherichia coli(3.5%),Coagulase-negative Staphylococci(6.4%) and Staphylococcus aureus(1.4%).The results of bacterial susceptibility test showed: Streptococcus pneumoniae,Pseudomonas aeruginosa,Acinetobacter baumanni and Escherichia coli were 100% resistant to Ampicillin and Compound Sulfamethoxazole;Escherichia coli and Klebsiella pneumoniae were 100% and Acimetobacter baumanni over 86.7% sensitive to Imipenem;Pseudomonas aeruginosa showed varying degrees of resistance to common antibiotics,with highest susceptibility to Amikacin(>76.2%),followed by Imipenem and Meropenem(>30%).Streptococcus pneumoniae,Staphylococcus aureus and Coagulase-negative staphylococci were resistant to Pennicillin and sensitive to Vancomycin in 100% of time.Conclusion Nosocomial Gram-negative bacilli were the most common pathogens in wards of respiratory diseases.Antibiotic resistance has become an increasing concern.Proper use of antibiotics and surveillance on antibiotic resistance appear crucial to prevent selection and wide spreading of drug-resistant strains.