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下呼吸道感染病原体流行和耐药现状分析
引用本文:WANG Wen-jing,王文晶,黄茂,HUANG Mao,赵旺胜,ZHAO Wang-sheng,殷凯生,YIN Kai-sheng.下呼吸道感染病原体流行和耐药现状分析[J].南京医科大学学报,2006,26(1):29-32.
作者姓名:WANG Wen-jing  王文晶  黄茂  HUANG Mao  赵旺胜  ZHAO Wang-sheng  殷凯生  YIN Kai-sheng
作者单位:南京医科大学第一附属医院呼吸科 江苏南京210029(王文晶,黄茂,殷凯生),南京医科大学第一附属医院检验科 江苏南京210029(赵旺胜)
摘    要:目的:了解下呼吸道感染病原体的流行情况、主要流行病原体的耐药现状以及一些特殊病原体如耐甲氧西林的葡萄球菌(MRS)、超广谱β-内酰胺酶(ESBLs)菌株等]的流行和耐药现状,为临床合理应用抗菌药物提供依据。方法:用WHONET5软件统计分析2004年南京医科大学第一附属医院住院患者3863份痰液标本培养及药敏结果。结果:下呼吸道感染病原体中,革兰阴性菌居首位,占所有阳性标本的50%;其次为真菌占33%。所有致病菌中,白色念珠菌位居第一(14%),铜绿假单胞菌位居其次(11%),不动杆菌属(8%)、肺炎克雷伯菌(8%)、热带念珠菌(7%)亦较为常见,耐药菌株比例较高。产ESBLs菌检出率为12%,对三、四代头孢菌素及氟喹诺酮类耐药比例较高。MRS占所有葡萄球菌的65%,以表皮葡萄球菌为主,对大环内酯类、氟喹诺酮类及头孢菌素类呈现高度耐药。结论:目前下呼吸道感染病原体中条件致病菌比例在逐年上升,多药耐药菌比例增加。针对产ESBLs菌株建议选用碳青霉烯类、哌拉西林/他唑巴坦,对MRS推荐用万古霉素,其他药物耐药率均较高。

关 键 词:下呼吸道  感染  病原菌  耐药  超广谱β-内酰胺酶  耐甲氧西林的葡萄球菌
文章编号:1007-4368(2006)01-0029-04
收稿时间:2005-05-19
修稿时间:2005年5月19日

Analysis of pathogens in low respiratory tract infection and their drug resistance
WANG Wen-jing,HUANG Mao,ZHAO Wang-sheng,YIN Kai-sheng.Analysis of pathogens in low respiratory tract infection and their drug resistance[J].Acta Universitatis Medicinalis Nanjing,2006,26(1):29-32.
Authors:WANG Wen-jing  HUANG Mao  ZHAO Wang-sheng  YIN Kai-sheng
Institution:Department of Respiration, 1.Department of Clinical Laboratory, the First Affiliated Hospital of NJMU, Nanjing 210029, China
Abstract:Objective: To investigate the status of common and special pathogens in low respiratory tract infection, such as MRS and ESBLs producing strains, and their drug resistance in order to provide evidence for clinical therapy. Methods: The cultured results of 3 863 sputum specimens isolated from inpatients during the whole year 2004 and the drug susceptibility of pathogens were analyzed by the software WHONET5. Results: During all pathogens, Gram-negative bacteria accounted for 50% while fungi accounted for 33%. candida albicans accounted for 14%, pseudomonas aeruginosa 11%, klebsiella pneumoniae 8%, acinetobacter sp 8% and candida tropicalis 7%. Bacteria producing extended-spectrum beta-lactamase (ESBLs) accounted for 12% which had high resistance to third and forth generation cephalosporins and fluoroquinolones. Methicillin-resistant staphylococcus (MRS) accounted for 65% of all staphylococcus, resisting significantly to macrolides, cephalosporins and fluoroquinolones. Conclusion: At present, The percentage of opportunistic pathogens and multidrug resistant pathogens in low respiratory tract infection increases with time. Carbopenems and piperacillin/ tazobactam were recommended for ESBLs-producing pathogens and Vancomycin for MRS.
Keywords:low respiratory  infection  pathogenic bacteria  drug resistance  ESBLs  MRS
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