呼吸内科下呼吸道感染病原菌分布及耐药性分析

目的 分析医院呼吸内科下呼吸道感染病原菌的分布及其耐药特点,评估临床初始经验性抗感染治疗与实验室药敏试验结果的符合率.方法 收集2009-2010年医院呼吸内科下呼吸道感染患者2630例,送检合格痰及支气管灌洗液标本1498份,分离鉴定病原菌并进行药敏试验,统计所分离菌株的分布及耐药性特点.结果 呼吸科住院下呼吸道感染患者病原学送检率为57.0％,检出率为28.6％,ICU送检率为91.3％,检出率为54.2％;共分离出革兰阴性杆菌266株,革兰阳性球菌11株,真菌1 52株;对革兰阴性杆菌敏感性最高的抗菌药物为碳青霉烯类及β-内酰胺类/酶抑制剂复合制剂、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦;利奈唑胺及万古霉素对革兰阳性球菌保持良好的抗菌活性;临床初始经验治疗与体外药敏试验的符合率为40.4％.结论 革兰阴性菌是下呼吸道感染的主要致病菌,不同菌种对抗菌药物的耐药性存在差异,应结合患者病原学检查结果及初始治疗后病情转归等因素综合考虑,合理选择抗感染治疗药物.

Distribution and drug resistance of pathogens causing lower respiratory tract infections in department of respiratory medicine

OBJECTIVE To analyze the distribution and antimicrobial resistance of pathogens isolated from the patients who were diagnosed as lower respiratory tract infections in department of respiratory medicine,and evaluate the accordant rate of initial empirical therapy and the result of drug susceptibility test.METHODS A total of 2630 cases of patients who were diagnosed as lower respiratory tract infections in department of respiratory medicine during 2009-2010 were collected,totally 1498 sputum and bronchoalveolar lavage fluid specimens were submitted,the identification and drug susceptibility testing of the pathogens were performed,statistical analysis of the distribution and the drug resistance of the pathogen isolated was carried out.RESULTS The survey showed that the submission rate of respiratory tract specimens was 57.0%,the detection rate was 28.6%,the submission rate and the detection rate of ICU were 91.3% and 54.2%;there were 266 strains of gram-negative bacilli,11 strains of gram-positive cocci,and 152 strains of fungi isolated;gram-negative bacilli were mostly susceptible to carbapenem antibiotics and complex of β-lactam antibiotics/β-lactamase inhibitors such as cefoperazone/sulbactam and piperacillin/tazobactam;linezolid and vancomycin kept good antimicrobial activity to gram-positive cocci;the accordant rate of clinical initial empirical therapy and drug susceptibility testing in vitro was 40.4%.CONCLUSION Gram-negative bacilli are the most common pathogens causing lower respiratory tract infections,varying in drug resistance,the physician should choose proper antimicrobial agents with considering clinical condition of the patients,the result of etiology and the disease outcome after the initial therapy.