某医院下呼吸道感染分离菌分布及耐药性监测

目的研究四川大学华西医院龙泉医院下呼吸道分离菌分布及耐药情况,为临床合理用药提供指导。方法采用法国生物梅利埃VITEK2COMPACT全自动微生物鉴定分析仪对2016年6月到2018年1月本院2363例下呼吸道感染患者标本进行细菌培养鉴定,并分析其耐药情况。结果下呼吸道感染检出菌株革兰氏阴性杆菌1028株,占88.62%;革兰氏阳性球菌132株,占11.38%;普通患者革兰氏阴性杆菌检出依次以流感嗜血杆菌、铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌较多;重症患者革兰氏阴性杆菌检出依次以铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌、流感嗜血杆菌较多;革兰氏阳性球菌均以金黄色葡萄球菌较多。氨苄西林对常见革兰氏阴性杆菌耐药较为严重,亚胺培南、妥布霉素、哌拉西林/他唑巴坦对常见革兰氏阴性杆菌较为敏感;万古霉素在金黄色葡萄球菌、肺炎链球菌及溶血葡萄球菌均未发现耐药菌株,苯唑西林、庆大霉素对金黄色葡萄球菌、肺炎链球菌及溶血葡萄球菌耐药程度较高。结论下呼吸道感染菌群分布及耐药分析有利于流行病学监测及院感的控制,对临床抗生素的合理应用以及多重耐药菌株产生的控制有重要的临床意义。

Distribution and Drug Resistance Monitoring of Isolated Bacteria from Lower Respiratory Tract Infection in a Hospital

Objective To study the distribution and drug resistance of bacteria isolated from lower respiratory tract in Longquan Hospital,West China Hospital,Sichuan University,and to provide guidance for rational drug use in clinic.Methods 2363 specimens of patients with lower respiratory tract infection in our hospital from June 2016 to January2018 were cultured and identified by the full automatic microbiological identification analyzer VITEK2 COMPACT,and their drug resistance was analyzed.Results 1028 strains of Gram-negative bacilli were detected in lower respiratory tract infection,accounting for 88.62%;132 strains of Gram-positive cocci,accounting for 11.38%;Haemophilus influenzae,Pseudomonas aeruginosa,Klebsiella pneumoniae,Escherichia coli,Acinetobacter baumannii were detected in the order of common patients;Pseudomonas aeruginosa and Acinetobacter baumannii were detected in the order of severe patients.Klebsiella pneumoniae,Acinetobacter baumannii,Escherichia coli and Haemophilus influenzae were more common;Staphylococcus aureus was more common in Gram-positive cocci.Ampicillin was more resistant to common gramnegative bacteria,imipenem,tobramycin and piperacillin tazobactam were more sensitive to common gram-negative bacteria;vancomycin was not found in Staphylococcus aureus,Streptococcus pneumoniae and Staphylococcus hemolyticus;oxacillin and gentamicin were resistant to Staphylococcus aureus,Streptococcus pneumoniae and Staphylococcus hemolyticus.The degree of drug resistance is high.Conclusion The analysis of bacterial flora distribution and drug resistance in lower respiratory tract infection is beneficial to epidemiological monitoring and nosocomial infection control,and has important clinical significance for rational application of antibiotics and the control of multiple drug-resistant strains.