呼吸内科住院患者下呼吸道感染病原菌分布及体外耐药性监测

目的监测湖南永州市中心医院呼吸内科住院患者下呼吸道感染病原菌分布及体外耐药情况,为临床抗生素合理使用提供依据。方法对湖南永州市中心医院2009年1月-2011年12月经痰培养阳性的994株病原菌的菌群分布及药敏试验进行回顾性分析。结果 2009-2011年共分离革兰阴性菌558株,感染率为56.1%,以肺炎克雷伯菌最常见,为295株,感染率为29.9%,其次以铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌感染多见,感染率分别为9.0%、5.5%、4.0%;分离革兰阳性菌351株,感染率为35.3%,以肺炎链球菌、金黄色葡萄球菌、肠球菌、表皮葡萄球菌多见,感染率分别为11.0%、8.6%、6.4%、5.4%;分离真菌85株,感染率为8.6%,以白色念珠菌为主,感染率为3.5%。不同年份肺部感染菌群中革兰阴性菌感染率比较,差异有统计学意义（P〈0.05）,并呈逐年上升态势。肺部感染病原菌对大多数抗生素有不同程度的耐药,革兰阴性菌对亚胺培南的敏感性最高,其次为β-内酰胺类酶抑制剂复合制剂。革兰阳性菌对万古霉素敏感。结论革兰阴性菌是下呼吸道感染的主要致病菌,根据药敏试验选择抗生素对临床耐药菌株的减少及治疗的有效性有重要的临床意义。

Distribution and drug resistance of lower respiratory tract infection pathogens in hospitalized patients of respiratory medicine department

Objective To monitor the distribution and drug resistance of lower respiratory tract infection pathogens in hospitalized patients of respiratory medicine department in Yongzhou Central Hospital of Hu＇nan Province,in order to provide basis for clinical rational use of antibiotics.Methods Bacterial flora distribution and drug sensitivity test of 994 strains of pathogenic bacteria cultured positive in sputum in Yongzhou Central Hospital of Hu＇nan Province from January 2009 to December 2011 were retrospectively analyzed.Results From 2009 to 2011,558 strains of Gram-negative bacteria isolated,the infection rate was 56.1%,among which 295 strains of Klebsiella pneumoniae were the most common infection pathogen,the infection rate was 29.9%,followed by Pseudomonas aeruginosa,Acinetobacter bau mannii,Escherichia coli infection,the infection rates were 9.0%,5.5%,4.0% respectively.351 strains of Gram-posi tive bacteria isolated,the infection rate was 35.3%,Streptococcus pneumoniae,Staphylococcus aureus,Enterococcus,Staphylococcus epidermidis were the common infection pathogens,the infection rates were 11.0%,8.6%,6.4%,5.4%.85 strains of fungi isolated,the infection rate was 8.6%,Candida albicans was the most common infection pathogen,the infection rate was 3.5%.The infection rates of Gram-negative bacteria of pulmonary infection had statistically sig nificant difference among the three years（P〈 0.05）,and its showed a rising trend with the year.Lung infection pathogenic bacteria had varying degrees of drug resistance to most antibiotics,Gram-negative bacteria had the highest sensitivity to Imipenem,followed by β-lactam type inhibitor compound preparation.Gram-positive bacteria had sensi tivity to Vancomycin.Conclusion Gram-negative bacteria is the main pathogens in lower respiratory tract infection.Selection of antibiotics according to the drug sensitive test has important clinical significance for reducing the clinical drug resistant strains and the effectiveness of treatment.