呼吸道感染的病原菌分布及耐药性分析

目的分析导致呼吸道感染的病原菌种类及其对抗菌药物的耐药性,指导临床合理用药及防止医院内感染。方法对2009年1～12月呼吸道感染患者送检标本中分离鉴定的致病菌及药敏结果进行归纳分析。结果在10381份送检标本中,检出病原菌798株(同一患者只取第1株菌),其中革兰阴性菌682株,占85.5%,革兰阳性菌116株,占14.5%。革兰阴性菌以肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌为主,革兰阳性菌以金黄色葡萄球菌、溶血葡萄球菌、粪肠球菌为主。检出产超广谱β-内酰胺酶(ESBLs)大肠埃希菌、肺炎克雷伯菌、产酸克雷伯菌共60株,阳性率分别为55.9%、25.8%和12.5%。金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌(MRSA)占46.0%。药敏结果因细菌种类、产酶情况各不相同,用药应根据细菌种类来确定。结论呼吸道感染病原菌以革兰阴性菌为主,病原菌种类主要以肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、金黄色葡萄球菌为主。检出病原菌对抗菌药物的耐药性较强,临床医生应注意对患者痰标本及时、多次送检,并根据细菌培养和药敏结果采取防治措施。

Pathogens detection and drug-resistance analysis in clinical respiratory infections

Objective To analyse the pathogens causing respiratory infection and their drug-resistance to antibiotic drugs for guiding clinical rational drug use and preventing nosocomial infection. Methods The pathogens isolated from the specimens collected in the patients with respiratory infections and the results of drug sensitivity tests from January to December 2009 were summarized and analyzed. Results in 10381 detected specimens,798 pathogenic strains were isolated（ taking the first strain in the same patient）, including 682 strains of Gram-negative bacteria （85.5 % ） , 116 strains of Gram positive bacteria（ 14; 5 % ）. The Gram-negative bacteria were mainly K. pneumonia, E. coli, P. aeruginosa and A. baumannii. The Gram-positive bacteria were dominated by S. aureus, S. haemolytieusand E. faecalis. ESBLS-producing E. coli, K. pneumonia, K. oxytocum and P. mirabilis were in 60 strains with the positive rate of 55.9%,25.8% and 12.5%. MRSA accounted for 46.0% of staphylococcus aureus. The results of drug sensitivity tests were different with various kinds of bacteria and enzyme-producing and medication should be selected according to the types of bacteria. Conclusion The pathogens of respiratory infection are mainly Gram negative bacteria and the types are dominated by K. pneumonia, E. coli, P. aeruginosa,A, baumannii and S. aureus. The detected bacteria have high resistance to antibacterial agents. Doctor should pay attention to timely and repeated detection in these patients and take the preventive measures according to the results of bacteria culture and drug sensitive tests.