2007-2012年我院呼吸科肺部感染病原菌的分布及耐药性变迁分析

发布时间：2018-04-05 00:31

本文选题：肺部感染　切入点：致病菌　出处：《广西医科大学》2013年硕士论文

【摘要】：目的：分析整理2007年1月1日—2012年12月30日这6年于广西医科大学一附属医院呼吸内科病房确诊为肺部感染(包括社区获得性肺炎和医院获得性肺炎)患者病原菌的构成及其耐药趋势,为临床医生选择抗菌药提供数据依据。方法：对2007年1月-2012年12月在广西医科大学一附属医院呼吸科诊断为肺部感染的8523例住院患者痰、支气管肺泡灌洗液及血液中分离出的病原菌,描述其构成比。调查近6年临床常见的革兰氏阴性杆菌对13种常用抗生素的药敏结果,探讨临床常见的革兰氏阴性杆菌的耐药变迁。用SPSS16.0、 SAS9.0软件进行统计分析,耐药率的逐年变化趋势,采用Cochran-Armitage趋势检验,以a=0.05(双侧)为显著性检验水准。结果：本次调查肺部感染住院患者送检了痰、支气管灌洗液、血液标本的有8523例,分离得到病原菌共1319株,检出率30.43%,其中93.2%来自痰标本,3.0%来自支气管肺泡灌洗液,3.79%来自血标本。根据我院近6年的药敏结果统计,培养出的病原菌排名前五位为肺炎克雷伯菌、大肠埃希氏菌、鲍曼氏不动杆菌、铜绿假单胞菌、阴沟肠杆菌。它们的比列分别占15.92%、13.42%、11.22%、9.86%、3.49%。分离出的革兰氏阳性球菌共50株(3.85%),主要为金黄色葡萄球菌、凝固酶阴性葡萄球菌、肠球菌和极少数的肺炎链球菌。分离出的真菌444株,其中以白色念珠菌(21.3%)为主,其所占比率逐年上升,由2007年的10.5%上升至2012年的23.78%,其他真菌如光滑念珠菌、近平滑念珠菌等所占比率有下降趋势。近6年来监测对革兰氏阴性杆菌敏感性最高的抗菌药物为碳青酶烯类的亚胺培南-西司他丁和美罗培南,未发现阴沟肠杆菌耐药株。敏感率高低依次：头孢哌酮舒巴坦阿米卡星头孢毗肟庆大霉素头孢他啶,耐药率最高的是新诺明、头孢噻肟、哌拉西林、氨曲南、环丙沙星和左氧氟沙星。对鲍曼氏不动杆敏感率最高是头孢哌酮／舒巴坦。肺炎克雷伯菌对头孢噻肟耐药率逐年上升；大肠埃希氏菌对氨曲南、阿米卡星、头孢噻肟耐药率逐年上升；铜绿假单胞茵对阿米卡星耐药率逐年下降、对复方新诺明耐药率逐年上升；鲍曼氏不动杆菌对头孢哌酮／舒巴坦、美罗培南、亚胺培南／西司他丁、头孢吡肟、氨曲南及复方新诺明耐药率呈逐年上升趋势,亚胺培南／西司他丁耐药率上升得最快.阴沟肠杆菌对13种抗菌药耐药率均无明显变化趋势。肺炎克雷伯菌和大肠埃希菌是产ESBLs的常见菌株.2012年肺炎克雷伯菌及大肠埃希菌产ESBLs率较2009年均升高。2012年及2009年肺炎克雷伯菌产ESBLs的菌株相比：头孢吡肟、头孢他定、氨曲南敏感率增高。美罗培南、亚胺培南／西司他丁一直保持着较好的的敏感性。2012年与2009年大肠埃希菌产ESBLs的菌株药物敏感率比较,头孢哌酮／舒巴坦、美罗培南、庆大霉素敏感率降低,而头孢吡肟、头孢他定敏感率升高.左氧氟沙星、环丙沙星、哌拉西林均耐药.革兰氏阳性球菌对临床常用的抗生素耐药率普遍较高；替考拉宁耐药率较低(2.94%),未发现对万古霉素及利奈唑胺耐药株。结论：广西医科大学一附属医院呼吸科肺部感染性疾病所分离出的致病菌中以革兰氏阴性杆菌为主；临床常见革兰氏阴性杆菌对抗菌药物均有不同程度的耐药,；临床上应及时掌握本地区病原菌及其耐药性的最新动态,合理使用抗生素；应充分认识到细菌耐药性监测对指导和帮助临床合理选择抗生素具有重要意义。
[Abstract]:Objective : To analyze the composition of pathogenic bacteria in the respiratory department of a hospital in Guangxi Medical University from January 1 , 2007 to December 30 , 2012 , and to provide data bases for clinical doctors to select antibiotics .

Methods : The sputum , bronchoalveolar lavage fluid and the pathogenic bacteria isolated from sputum , bronchoalveolar lavage fluid and blood were analyzed in the respiratory department from January 2007 to December 2012 in the respiratory department of the Affiliated Hospital of Guangxi Medical University . The drug resistance changes of 13 common antibiotics were investigated in the past six years . The data were analyzed by SPSS 16.0 and SAS9.0 software . The trend of drug resistance was analyzed by SPSS 16.0 , SAS9.0 software . A = 0.05 ( double side ) was used as the significance test level .

Results : There were 8523 cases of sputum , bronchoalveolar lavage fluid and blood specimen in hospitalized patients with pulmonary infection . Among them , 1319 strains were isolated from sputum specimens , 3 . 0 % from bronchoalveolar lavage fluid and 3.79 % from blood specimens .
The resistance of Escherichia coli to aztreonam , amikaine and ceftiofur was increased year by year .
The drug resistance rate of the pseudomonas aeruginosa was decreased year by year , and the drug resistance rate of compound sulfamethoxazole increased year by year .
Compared with the strains produced by Klebsiella pneumoniae and Escherichia coli in 2012 and 2009 , the sensitivity of cefpime and cefcapram was higher than that in 2009 .
The resistance rate of teicoplanin was low ( 2.94 % ) and vancomycin and linezolid - resistant strains were not found .

Conclusion : Gram - negative bacilli in the pathogenic bacteria isolated from lung infectious diseases in the respiratory department of the Affiliated Hospital of Guangxi Medical University are mainly Gram - negative bacilli ;
The clinical common gram negative bacilli have different degrees of resistance to antibiotics .
In clinic , the latest developments of pathogenic bacteria and their drug resistance in the region should be mastered in a timely manner , and antibiotics should be reasonably used ;
It should be fully recognized that the monitoring of bacterial resistance is of great importance to the guidance and help of clinically reasonable choice of antibiotics .

【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.1

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