下呼吸道感染的病原菌分布与耐药性分析

目的：分析临床下呼吸道感染病原菌构成及耐药情况,以指导临床医师合理应用抗菌药物.方法：分析2008年1月-2012年12月解放军总医院第一附属医院从痰（19 365份）、支气管灌洗液（4 203份）以及支气管肺泡灌洗液（302份）标本分离细菌的鉴定及药敏试验结果.结果：共分离出非重复病原菌10 635株,其中革兰阴性杆菌5 244株（49.3%）,革兰阳性球菌2 495株（23.5%）,真菌2 896株（27.2%）.未发现葡萄球菌属对万古霉素、替考拉宁和利奈唑胺的耐药菌株,发现3株大肠埃希菌和32株肺炎克雷伯菌对碳青霉烯类耐药菌株（CRE）,多重耐药铜绿假单胞菌（MDRPA）和鲍曼不动杆菌（MDRAB）分别占14.2%和46.3%.真菌以白色念珠菌为主,对抗真菌药较敏感.结论：下呼吸道感染分离的病原菌中鲍曼不动杆菌、铜绿假单胞菌和金黄色葡萄球菌是主要病原菌,同时耐碳青霉烯类的肠杆菌科细菌（CRE）以及耐万古霉素的肠球菌属（VRE）也是临床抗感染治疗的难点.

Analysis of distribution and drug resistance of pathogens causing lower respiratory tract infections

Objective：To analyze the distribution of pathogenic bacteria and their resistance to antibiotics in patients with lower respiratory tract infection, in order to better guide clinical treatment of antibiotics. Methods：The clinical specimens including sputum （19 365）, bronchial lavage fluid （4 203） and bronchoalveolar lavage fluid （302） were collected from patients admitted to the First Hospital Affiliated to the Chinese PLA General Hospital from January 2008 to December 2012. The pathogenic bacteria were isolated and identified, and the drug suscepti- bility test was performed. Results： A total of 10 635 non repetitive bacteria were isolated. Among them, gram- negative bacilli consisted of 5 244 strains （49.3 %）, gram positive cocci bacteria 2 495 strains （23.5 % ）, and fungi 2 896 strains （27.2%） . No Staphylococci were found to be resistant to vancomycin, teicoplamin and linezolid. Three strains of E. coli and 32 strains of K. pneumonia were resistant to carbapenems. There were 14.2% of P. aeruginosa isolates and 46.3% of Acinetobacter baumannii showing multi-drug resistance. Candida albicans were found to be sensitive to most antifugal drugs . Conclusions：Aeinetobaeter baumannii, P. aeruginosa and Staphylo- coccus aureus are still the main pathogenic bacteria causing lower respiratory tract infections. Meanwhile,carbap enem-resistant enterobacteriaceae and vancomycin -resistant enteroeoceus （VRE） are still adamantly resistant to common clinical anti-infection treatment.