2011-2014年下呼吸道感染病原菌分布及耐药性分析

摘要:目的　了解医院下呼吸道感染患者痰标本病原菌分布和耐药性，为临床合理用药提供依据。方法　对2011-2014年医院下呼吸道感染患者痰标本中病原菌耐药性进行回顾性研究。采用珠海迪尔医学细菌测定系统进行细菌鉴定和药敏试验。结果　12200份痰标本中分离病原菌4559株，检出率为37.37%。其中革兰阴性杆菌93.57%，排列前四位的细菌是铜绿假单胞菌菌（27.79%）、鲍曼不动杆菌（17.77%）、肺炎克雷伯菌（17.70%）和大肠埃希菌（6.89%）；革兰阳性球菌占3.99%，以金黄色葡萄球菌为主（1.21%）；真菌占2.44%，以白假丝酵母菌最多（1.69%）。药敏结果显示，下呼吸道感染病原菌对大部分抗生素有不同程度耐药且耐药特点各不相同。4年中铜绿假单胞菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢吡肟、美罗培南、阿米卡星和多黏菌素B耐药率始终低于30%，其平均耐药率分别为11.60%、5.84%、11.05%、16.50%、12.00%和5.13%；鲍曼不动杆菌对米诺环素和多黏菌素B较为敏感，耐药率分别为7.16%、2.22%；肺炎克雷伯菌对亚胺培南和美罗培南的耐药率为4.21%；大肠埃希菌对亚胺培南的耐药率为0.00%。未检出耐万古霉素、利奈唑胺和替考拉宁的金黄色葡萄球菌以及耐氟胞嘧啶和两性霉素B的白假丝酵母菌。结论　下呼吸道感染病原菌耐药情况较为严重，应规范抗生素的使用，控制细菌耐药性变异的发生。

Distribution and drug resistance of pathogens causing lower respiratory tract infection, 2011-2014

Abstract: Objective To investigate the distribution and drug resistance of pathogens in lower respiratory tract sputum specimens so as to provide reference for the rational use of antibiotics. Methods The drug resistance of the pathogens isolated from lower respiratory tract sputum specimens during 2011-2014 were retrospectively analyzed. The bacterial identification and drug susceptibility test were performed with Auto microbial ID/AST analyzer from Zhuhai DL Medical Biotech Co.LTD. Results A total of 4559 bacteria strains were separated from 12200 phlegm samples. The detection rate of pathogenic bacteria was 37.37%. Gram-negative bacilli comprised 93.57% of the total bacterial population. The four common bacteria were P.aeruginosa (27.79%), A.baumannii (17.77%), K.pneumoniae (17.70%) and E.coli (6.89%), respectively. Gram-positive coccus accounted for 3.99%, and the major bacteria was S.aureus (1.21%). The fungi accounted for 2.44%, and the most predominant fungus was C.albican (1.69%). The drug sensitivity test showed that the pathogenic bacteria, which can cause pulmonary infections, had different degrees of resistance to many antibiotics. The antibiotics with the drug resistance rates of P.aeruginosa less than 30.00% in these four years were piperacillin/tazobactam, cefoperazone/sulbactam, cefepime, meropenem, amikacin and polymyxin B. The average drug resistance rates of them were 11.60%, 5.84%, 11.05%, 16.50%, 12.00% and 5.13%, respectively. The drug resistance rates of A.baumannii to minocycline and polymyxin B were 7.16% and 2.22%. K.pneumoniae had 4.21% resistance to imipenem and meropenem. E.coli had 0.00% resistance to imipenem. The resistance rates of S.aureus to vancomycin, linezolid and teicoplanin were 0.00%. No strains of C.albicans was found resistant to flucytosine and amphotericin B. Conclusion The pathogenic bacteria that caused lower respiratory tract infection show severe drug resistance to antibiotics. Thus, antibiotic use should be standardized to control the variation in bacterial drug resistance.