呼吸内科下呼吸道感染患者病原菌构成及耐药性分析

目的明确呼吸内科医院获得性肺炎(CAP)、社区获得性肺炎(HAP)和医院保健性获得性肺炎(HCAP)病原菌构成及耐药情况,为临床抗菌药物的应用提供依据。方法采用回顾性监测的方法,调查2008年11月～2010年6月呼吸内科下呼吸道感染患者痰标本分离出的病原菌及耐药情况。结果共检出病原菌510株,其中革兰阴性菌373株(73.14%),以铜绿假单胞菌、克雷伯菌属、大肠埃希菌和鲍曼不动杆菌为主要病原菌;革兰阳性菌82株(16.08%),主要为肺炎链球菌和金黄色葡萄球菌;真菌55株(10.78%),以白假丝酵母菌为主。G-菌对美罗培南、亚胺培南、哌拉西林/他唑巴坦、阿米卡星、庆大霉素、妥布霉素、头孢吡肟、头孢他啶敏感性较好,耐药率﹤30.00%。G+菌对红霉素、克林霉素、环丙沙星、四环素、庆大霉素的耐药率﹥60.00%。真菌对酮康唑敏感率为100.00%。结论呼吸内科下呼吸道感染患者的主要病原菌为革兰阴性杆菌,进行细菌培养和药物耐药性分析,对合理选用抗菌药物具有重要意义。

Distribution and Drug-resistance analysis of Pathogens from Lower Respiratory Tract Infection among Patients in Respiratory Department

OBJECTIVE To determine the distribution and drug resistance characteristic of pathogens from Patients with CAP,HAP and HCAP in Respiratory Department,and provide reference for selecting clinical antibiotics.METHODS By retrospective analysis,the distribution and drug-resistance of the patients with lower respiratory tract infection from Nov.2008 to Jun.2010 were analyzed.RESULTS Among 510 strains of pathogens,the Gram-negative bacilli(GNB)accounted for 73.14%,the major bacteria were Pseudomonas aeruginosa,Klebsiella pneumoniae,Escherichia coli and Acinetobacter baumannii.The Gram-positive bacteria(GPB)accounted for 16.08%,the major bacteria were Staphylocouus aureus and Streptococcus pneumoniae.The fungi accounted for 10.78%,and the most predominant was C.albican.Gram-negative bacteria were susceptible to meropenem,imipenem,amikacin,piperacillin/tazobactam,gentamicin,tobramicine,cefepime and ceftazidime,and the drug resistance rate was less than 30%.Gram-positive bacteria were highly resistant to erythromycin,clindamycin,ciprofloxiacin,tetracycline and gentamicin,and the drug resistance rate was more than 60.00%.100.00% of fungi were sensitive to ketoconazole.CONCLUSION GNB was still the most important pathogens in Lower Respiratory Tract Infection and had multiple drug resistance.Bacterial culture and drug-resistance tests was very important to correctly select antibiotics.