医院下呼吸道感染病原菌的分布与耐药性分析

目的探讨院内下呼吸道感染常见病原菌分布及耐药情况,为临床医师合理用药提供科学依据。方法采用天地人微生物分析系统,对2009年1月～2011年7月在本院诊断为下呼吸道感染的住院患者的痰液标本进行分离培养鉴定和药敏试验。结果 3950份痰液中分离出病原菌1189株,病原菌分离率为30.10%。其中革兰阴性(G-)杆菌834株(70.14%),主要为铜绿假单胞菌、大肠埃希菌和肺炎克雷伯菌;革兰阳性(G+)球菌263株(22.12%),主要为金黄色葡萄球菌和表皮葡萄球菌;真菌92株(7.74%)。165株肺炎克雷伯菌中ESBLs阳性菌39株,占23.64%;205株大肠埃希菌中ESBLs阳性菌45株,占21.95%;87株金黄色葡萄球菌检出MRSA 13株,占14.94%;134株凝固酶阴性葡萄球菌检出MRCNS 21株,占15.67%。美洛培南对G-杆菌具高度敏感性,未发现耐万古霉素的葡萄球菌。结论 G-杆菌是下呼吸道感染的主要病原菌,耐药率较高,并呈多重耐药趋势,美洛培南对G-杆菌具良好敏感性,万古霉素对G+球菌具高度敏感性,临床应根据药敏试验结果合理选用抗菌药物。

The Analysis of Drug Resistance and Distributed for Respiratory Tract Infection Pathogens in Hospital

Objective To investigate the bacterial distribution and resistance to antibiotica from low-respiratory tract infections of the hospitalized for the hospital and to provide a scientific basis for rational drug use for clinicians.Methods Diagnosed as lower respiratory tract infection in hospitalized patients with sputum specimens for identification and susceptibility testing were isolated and cultured In our hospital bewteen January,2009 to July,2011 by ＂TIANDIREN＂microbial identification system.Results 3950 sputum of isolated pathogen 1189 strains and the Isolation rate of pathogens was 30.10%.Including gram-negative bacteria（G-）834 strains（70.14%）,mainly for pseudomonas aeruginosa,escherichia coli and pneumonia crayresearch bacteria,Gram-positive staphylococcus（G＋） 263strains（22.12%）,mainly for staphylococcus aureus and staphylococcus epidermidis,Fungi 92 strains（7.74%）,165 ESBLs in Klebsiella pneumoniae-positive bacteria 39 strains,accounted for 23.64%,205 E.coli ESBLs-positive bacteria 45 strains,accounting for 21.95%,87 detection of MRSA 13 Staphylococcus aureus strains,accounting for 14.94%,134 coagulase-negative staphylococci detected MRCNS 21 strains,accounting for 15.67%,Meropenem for the G-bacteria with high sensitivity and found no vancomycin-resistant Staphylococcus aureus.Conclusions G-bacteria is a major pathogen of lower respiratory tract infection,drug resistance is higher,and showed multiple drug resistance,meropenem for the G-bacteria with good sensitivity,vancomycin against G＋ bacteria with high sensitivity,the clinical results of susceptibility testing should be based on rational use of antimicrobial drugs.