下呼吸道感染病原菌的分布及耐药变迁分析

发布时间：2018-05-07 07:59

本文选题：下呼吸道感染 + 病原菌　；参考：《重庆医科大学》2015年硕士论文

【摘要】：目的：了解呼吸内科住院患者下呼吸道感染病原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(简称重医一院)呼吸内科3155例下呼吸道感染患者的下呼吸道分泌物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：三年来下呼吸道感染病原体位居前三位的一直是鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌,金黄色葡萄球菌感染率上升,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,唯有对米诺环素敏感性达70%以上,对其他各类抗生素敏感性都不足40%,监护室(Intensive care unit, ICU)敏感率更低,且在普通病房中药物敏感性有下降趋势,ICU中无明显变化；普通病房中分离的铜绿假单胞菌药物敏感率大于70%的抗菌素的有头孢吡肟、美罗培南、亚胺培南、左氧氟沙星、环丙沙星,监护室中各类抗菌药物敏感率在50%-70%之间。近3年除对哌拉西林、哌拉西林／他巴唑他敏感性有所下降,对其余抗生素无明显变化。但耐碳青霉烯类鲍曼不动杆菌、铜绿假单胞菌菌株数较多存在。嗜麦芽窄食单胞菌对米诺环素、左氧氟沙星敏感性较高。金黄色葡萄球菌对替加环素、利奈唑胺、万古霉素的敏感性一直保持在100%,但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、头孢吡圬敏感性一直保持在80%以上,但ESBL阳性肺炎克雷伯菌菌株开始出现。流感嗜血杆菌一直对美罗培南、头孢他啶、头孢呋辛、环丙沙星、左氧氟沙星、阿莫西林-克拉维酸钾敏感性保持在85%以上。肺炎链球菌对万古霉素敏感性一直保持在100%,对左氧氟沙星、青霉素G的敏感性在80%-96%之间。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感染主要病原菌,较多耐碳青霉烯类鲍曼不动杆菌、铜绿假单胞菌存在,ESBLs阳性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生素,有效控制和减缓细菌耐药性的增长是当务之急。
[Abstract]:Objective: to investigate the distribution of pathogenic bacteria and drug sensitivity of lower respiratory tract infection in inpatients with respiratory medicine, so as to provide reference for initial anti-infective drugs. Methods: in 2013, 3155 patients with lower respiratory tract infection in Department of Respiratory Medicine, the first affiliated Hospital of Chongqing Medical University, were isolated, cultured and tested for drug sensitivity, and the results were compared with those in 2011 and 2012. Results: Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus and Staphylococcus maltophilia were the top three pathogens of lower respiratory tract infection in the past three years. The isolation rate of Streptococcus pneumoniae has been low. Acinetobacter baumannii multidrug resistance was serious. The sensitivity to minocycline was more than 70%, and the sensitivity to other antibiotics was less than 40%. The sensitive rate of intensive care unit, ICU) in intensive care unit was even lower. There was no significant change in drug sensitivity in ICU, cefepime, meropenem, imipenem, levofloxacin were found in antibiotics with susceptibility rate of more than 70%. Ciprofloxacin, the sensitivity of all kinds of antimicrobial drugs in the intensive care unit was between 50% and 70%. In the last 3 years, the sensitivity of piperacillin to piperacillin was decreased, but not to other antibiotics. But acinetobacter baumannii and Pseudomonas aeruginosa were resistant to carbapenem. The sensitivity of Stenotrophomonas maltophilia to minocycline and levofloxacin was higher. The sensitivity of Staphylococcus aureus to tegacycline, linazolamine and vancomycin remained at 100, but MRSA increased year by year. The susceptibility of Klebsiella pneumoniae, Escherichia coli to imipenem, piperacillin, and cefepiramidine remained above 80%, but ESBL positive Klebsiella pneumoniae strains began to appear. Haemophilus influenzae remain sensitive to meropenem, ceftazidime, cefuroxime, ciprofloxacin, levofloxacin, amoxicillin-potassium clavulanate over 85%. The sensitivity of Streptococcus pneumoniae to vancomycin remained at 100 and to levofloxacin, penicillin G was between 80 and 96%. Conclusion: Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae are the main pathogens of lower respiratory tract infection in inpatients. The presence of ESBLs-positive Klebsiella pneumoniae in Pseudomonas aeruginosa increased the number of MRSA isolates, which increased the difficulty of clinical treatment. It is urgent to select antibiotics according to drug sensitivity results to effectively control and slow the increase of bacterial drug resistance.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R446.5

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