下呼吸道感染患者病原菌分布及耐药情况分析

发布时间：2018-05-29 12:24

本文选题：呼吸内科 + 下呼吸道感染　；参考：《现代预防医学》2014年20期

【摘要】：目的分析某院呼吸内科下呼吸道住院患者痰标本病原菌分布情况及耐药特征,为临床治疗提供参考依据。方法收集2010年3月-2013年10月间,该院呼吸内科住院治疗的下呼吸道感染患者1 543例进行痰液标本检验,分析标本中病原菌的检出情况及主要致病菌对常用抗菌药的耐药情况。结果 1 543名患者送检标本中,分离得到病原菌689份,检出率为44.6%。共分离出革兰阴性菌431株(62.6%),革兰阳性菌203株(29.5%),真菌55株(8.0%)。在革兰阴性菌中,铜绿假单胞菌所占构成比最高(19.3%),其次为肺炎克雷伯菌102株(14.8%);革兰阳性菌中所占比例最大的为肺炎链球菌(12.2%),其次为金黄色葡萄球菌53株(7.7%);白假丝酵母菌在真菌中所占比例最大(3.5%)。铜绿假单胞菌耐药最严重的几种药物分别为头孢曲松(92.1%)、头孢噻肟(84.3%)及奈替米星(52.7%);肺炎克雷伯菌耐药较为严重的几种药物为环丙沙星(59.1%)、庆大霉素(58.6%)以及阿莫西林克拉维酸(53.2%);鲍曼不动杆菌耐药率较高的几种药物为阿莫西林克拉维酸(99.4%)、氨曲南(91.1%)以及头孢噻肟(81.0%)。在革兰阳性菌种,肺炎链球菌耐药率较高的药物为四环素(97.3%)、红霉素(92.7%)以及环丙沙星(90.5%);金黄色葡萄球菌耐药较为严重的几种药物为红霉素(95.4%)、庆大霉素(91.6%)及四环素(90.0%);表皮葡萄球菌耐药严重的几种药物为红霉素(98.3%)、四环素(91.9%)及庆大霉素(90.5%)。结论在该院呼吸内科住院患者中,革兰阴性菌感染所占比例较高,其中铜绿假单胞菌成为革兰阴性菌中的主要致病菌。各类致病菌的耐药率也不尽相同,临床治疗时应根据致病菌检验结果及药敏实验合理治疗用药。
[Abstract]:Objective to analyze the distribution of pathogenic bacteria and drug resistance of sputum specimens in lower respiratory tract inpatients of respiratory department in a hospital, and to provide reference for clinical treatment. Methods from March 2010 to October 2013, 1 543 patients with lower respiratory tract infection treated in Department of Respiratory Medicine in our hospital were collected for sputum examination, and the detection of pathogenic bacteria and resistance of main pathogenic bacteria to common antibiotics were analyzed. Results 689 strains of pathogenic bacteria were isolated from 1 543 samples, and the detection rate was 44.6%. A total of 431 Gram-negative bacteria were isolated, 203 Gram-positive bacteria were isolated, and 55 fungi were isolated. In Gram-negative bacteria, Pseudomonas aeruginosa accounted for the highest proportion of 19.3%, followed by Klebsiella pneumoniae 102 strains and 14.8%; Gram-positive bacteria accounted for the largest proportion of Streptococcus pneumoniae 12.2G, followed by Staphylococcus aureus 53 strains of Staphylococcus aureus, and Candida albicans accounted for the largest proportion of the fungi 3.5%. The most serious drug resistance of Pseudomonas aeruginosa were ceftriaxone 92.1, cefotaxime 84.3) and netilmicin 52.7. The more severe drug resistance of Klebsiella pneumoniae was ciprofloxacin 59.1m, gentamicin 58.6m) and amoxicillin. Several drugs with higher resistance rate of Acinetobacter baumannii were amoxicillin clavulanate 99.4m, amoxicillin 91.1) and cefotaxime 81.0. In Gram-positive strains, The higher resistance rate of Streptococcus pneumoniae is tetracycline 97.3 and erythromycin 92.7) and ciprofloxacin 90.5. The more serious drug resistance of Staphylococcus aureus is erythromycin 95.4um and gentamicin 91.6) and tetracycline 90.0am; Staphylococcus epidermidis resistance. The serious drugs were erythromycin 98.3 and tetracycline 91.9) and gentamicin 90.5. Conclusion the proportion of Gram-negative bacteria infection is high in the inpatients of respiratory department of this hospital, among which Pseudomonas aeruginosa is the main pathogenic bacteria in Gram-negative bacteria. The drug resistance rate of various pathogenic bacteria is different, and the clinical treatment should be based on the results of pathogenic bacteria test and drug sensitivity test.
【作者单位】：湖北省中山医院呼吸内科;湖北省中山医院肝病科;武汉市第一医院病理科;
【分类号】：R56

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