厦门三甲医院院内获得性肺炎病原菌分布及其耐药性分析

目的探讨厦门地区二所三甲医院院内肺部感染主要病原菌及其耐药性的特点,为本地区临床合理使用抗生素提供依据。方法回顾分析2009年期间成人住院病人发生院内肺部感染的有关资料。结果 447例院内肺部感染患者分离出476株病原菌,院内肺部感染病原菌中主要的4种革兰氏阴性菌为铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌和大肠埃希氏菌。3种主要革兰氏阳性菌为,金黄色葡萄球菌、凝固酶阴性葡萄球菌和粪肠球菌。病原菌种类多、复杂,容易产生耐药性。对磺胺类、青霉素、庆大霉素及红霉素基本耐药,对头孢第三代大部分耐药,对其他β-内酰胺类及其复合物较敏感,本组未发现对万古霉素耐药菌株。结论治疗成人院内肺部感染开始时应经验性用药,后应重视病原学检查,根据药敏结果针对性治疗,从而达到较好的治疗效果及减少耐药菌株的产生。

The analysis of pathogenic bacteria and their drug resistance in adult nosocomial pulmonary infection in 3rd Level 1st Class hospitals in Xiamen

Objective To investigate the main pathogenic bacteria and their characteristics of drug resistance in adult nosocomial pulmonary infection in two 3rd Level 1st Class hospitals,and to provide the basis for clinical rational use of antibiotics in local region.Methods The data of adult nosocomial pulmonary infection cases in two 3rd Level 1st Class hospitals in 2009 was analyzed retrospectively.Results Four hundred seventy-six strains of pathogenic bacteria were identified from 447 cases of adult nosocomial pulmonary infection.Four major Gram-negative pathogenic bacteria were pseudomonas aeruginosa,Acinetobacter baumannii,and klebsiella pneumoniae and Escherichia coil,and three major Gram-positive pathogenic bacteria were Staphylococcus aureus,coagulase-negative Staphylococcus and Enterococcus faecalis.These bacteria had the characteristic of wide variety,complexity and easy to form drug resistance.Majorty of them resist to sulfa,penicillin,gentamycin and erythromycin.Some resisted to 3rd-generation cephalosporin but were sensitive to other β-lactams antibiontics and their complexes.No strain resisted to vancomycin.Conclusion Empirical medication should be used in the initial stage of nosocomial pulmonary infection,and attention should be paid on pathogenic bacteria detection thereafter.In order to gain better therapeutic effect and reduce drug resistance,therapy should be based on antibiotic susceptibility.