社区获得性下呼吸道重症感染病原菌及耐药性分析

目的　了解社区获得性下呼吸道重症感染病原菌的主要种类分布及耐药情况。方法　收集我院呼吸重症监护室 2 0 0 2年 6月至 2 0 0 3年 6月的 80例社区获得性下呼吸道重症感染患者的 65株病原菌及其药敏实验结果 ,进行分析。结果　 65株细菌中革兰阳性球菌 3 6株 ( 5 5 .4% ) ,革兰阴性杆菌 2 4株 ( 3 6.9% ) ,真菌 5株 ( 7.7% )。革兰阳性球菌主要为肺炎链球菌 ( 13 .9% ,) ,表皮葡萄球菌 ( 12 .3 % ) ,金黄色葡萄球菌 ( 12 .3 % ) ,粪肠球菌 ( 7.7% ) ,其中青霉素耐药的肺炎链球菌 (PRSP)占 11.0 % ,甲氧西林耐药的金黄色葡萄球菌 (MRSA )占 11.0 %。革兰阴性杆菌主要为铜绿假单孢菌( 12 3 % ) ,大肠埃希菌 ( 7.7% ) ,鲍曼氏不动杆菌 ( 7.7% ) ,非发酵菌检出率高达 2 0 % ,以铜绿假单孢菌为主 ,发现嗜麦芽窄食单孢菌 4株 ( 6.2 % ) ,对多数常见抗生素耐药。真菌感染中白色念珠菌 4例 ,烟曲菌 1例。结论　本研究收集的社区获得性下呼吸道重症感染 65株致病菌以革兰阳性球菌为主 ,其次为革兰阴性杆菌 ,亦有少量的真菌感染。多数病原菌具有多重耐药性 ,回顾性分析细菌耐药性对临床经验性用药具有重要参考价值。

Analysis of classification and drug resistance of pathogenic bacteria in severe community acquired lower respiratory infection

Objective To investigate the classification and the drug resistance of bacteria in severe community acquired lower respiratory infection. Methods The classification and the drug resistance test of 65 strains of pathogenic bacteria isolated from 80 patients in Respiratory Intensive Care Unit (RICU) from June 2002 to June 2003 were analyzed retrospectively. Results In 65 strains, there were 36 (55.4%) strains of gram-negative bacteria, 24 (36.9%) strains of gram-positive bacteria, and 5 (7.7%) strains of fungi. The main gram-negative bacteria included Streptococcus pneumoniae (13.9%), Staphylococcus epidermidis (12.3%), Staphylococcus aureus (12.3%), and E. faecium (7.7%). There were 8 stains of penicillin resistant strains of Streptococcus pneumorriae (PRSP11.0%). Methicillin resistant strains of Staphylococcus aureus (MRSA) accounted for 11.0%. The main gram-negative bacteria included Pseudomonas aeruginosa (12.3%), Escerichia coli (7.7%), and A. baumanuii (7.7%). Nonfermentative gram-negative bacteria accounted for 20%. Resistant rates of 4 (6.2%) strains of Stenotrophomonas maltophi-lia resistant to commonly used antibiotics were high. There were 4 (6.3%) strains of Candida albicans and 1 strain of Asperigillus fumigatus in fungal infection. Conclusion The 65 strains of pathogenic bacteria include mainly gram-negative bacteria, gram-positive bacteria, and a small amount of fungus infection. Most pathogenic bacteria demonstrate multi-drug resistance. Retrospective analysis of the drug resistance of bacteria is of great significance in the empirical use of antimicrobial agents.