下呼吸道临床分离菌的分布及敏感性变迁

发布时间：2018-03-13 01:36

本文选题：下呼吸道　切入点：分离菌　出处：《中国感染与化疗杂志》2016年03期 　论文类型：期刊论文

【摘要】：目的了解呼吸内科中下呼吸道感染患者分离菌的分布及药物敏感性,为临床初始抗感染用药提供参考。方法对2013年重庆医科大学附属第一医院呼吸内科3 155份下呼吸道标本进行分离培养和药敏试验,并同时与2011年、2012年检测结果进行比较。结果 3年来下呼吸道分离菌居前3位的一直是鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌;金黄色葡萄球菌(金葡菌)分离率上升,嗜麦芽窄食单胞菌、肺炎链球菌分离率一直较低。鲍曼不动杆菌多重耐药现象严重,除对米诺环素敏感率达60%以上,对其他各类抗菌药物敏感率都不足40%,ICU较普通病房中敏感率更低,非ICU中敏感率有下降趋势;非ICU中分离的铜绿假单胞菌药物敏感率70%的抗菌药物有头孢吡肟、美罗培南、亚胺培南、左氧氟沙星、环丙沙星,ICU中各类抗菌药物敏感率在50%~70%,3年中敏感率无明显变化。然而分离到耐碳青霉烯类鲍曼不动杆菌、铜绿假单胞菌菌株。嗜麦芽窄食单胞菌对米诺环素、左氧氟沙星敏感率较高。金葡菌对替加环素、利奈唑胺、万古霉素的敏感率在100%,但耐甲氧西林金葡菌(MRSA)逐年增多。肺炎克雷伯菌、大肠埃希菌对亚胺培南、哌拉西林-他巴唑坦、头孢吡圬敏感率在80%以上,但存在产ESBL肺炎克雷伯菌。流感嗜血杆菌对美罗培南、头孢他啶、头孢呋辛、环丙沙星、左氧氟沙星、阿莫西林-克拉维酸敏感率在85%以上。肺炎链球菌对万古霉素敏感率为100%,对左氧氟沙星、青霉素的敏感率在80%~96%。结论鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌成为住院患者下呼吸道分离主要细菌。耐碳青霉烯类鲍曼不动杆菌、铜绿假单胞菌、产ESBL肺炎克雷伯菌开始出现,MRSA分离株数逐年增多,增加了临床治疗的难度。根据药敏结果选择抗菌药物,有效控制和减缓细菌耐药率的增长是当务之急。
[Abstract]:Objective to investigate the distribution and drug sensitivity of bacteria isolated from patients with lower respiratory tract infection in Department of Respiratory Medicine. Methods in 2013, 3 155 samples of lower respiratory tract in Department of Respiratory Medicine affiliated to Chongqing Medical University were isolated, cultured and tested for drug sensitivity. Results in the last three years, Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus (Staphylococcus aureus) and Staphylococcus aureus (Staphylococcus aureus) were among the top 3 isolates. The isolation rate of Streptococcus pneumoniae was always low. Acinetobacter baumannii showed severe multidrug resistance, and the susceptibility to minocycline was more than 60%. The susceptibility to other antimicrobial agents was less than 40% in ICU, and the sensitivity rate in non ICU was lower than that in general ward, and the antimicrobial susceptibility rate of 70% in non ICU isolates was cefepime and meropenem. The susceptibility rates of various antimicrobial agents in ICU, such as imipenem, levofloxacin and ciprofloxacin, were 50% and 70% respectively. However, the susceptibility rate of acinetobacter baumannii to carbapenem was not significantly changed in 3 years. Pseudomonas aeruginosa strain. High susceptibility of Staphylococcus maltophilia to minocycline and levofloxacin. The susceptibility rate of vancomycin was 100, but the resistance to methicillin-resistant Staphylococcus aureus increased year by year. The susceptibility rates of Klebsiella pneumoniae and Escherichia coli to imipenem, piperacillin and tazobazolam were more than 80%. Haemophilus influenzae against meropenem, ceftazidime, cefuroxime, ciprofloxacin, levofloxacin, The sensitivity of Streptococcus pneumoniae to vancomycin is more than 85%, and to levofloxacin, penicillin is more than 80%. Conclusion Acinetobacter baumannii, Pseudomonas aeruginosa, Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae has become the main bacteria isolated from the lower respiratory tract of inpatients. Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae producing ESBL have been increasing year by year. It is urgent to select antimicrobial agents according to the results of drug sensitivity and to control and slow down the increase of bacterial drug resistance rate.
【作者单位】：重庆医科大学附属第一医院呼吸内科;
【基金】：国家临床重点专科建设项目(卫办医政函[2012]649号)
【分类号】：R446.5

【相似文献】