基层医院下呼吸道感染病原学及耐药分析

发布时间：2018-08-22 09:03

【摘要】：目的了解下呼吸道感染患者病原菌的构成、对药物敏感度及耐药性情况,总结经验性抗生素使用效果,指导临床对下呼吸道感染患者正确进行经验性抗生素治疗,减少耐药菌发生。根据药敏结果合理应用抗生素,减少ICU病房细菌耐药的发生。对象与方法本研究通过对咸水沽医院(二级甲等医院)2010年3月-2013年3月1312例下呼吸道感染患者的痰液标本进行痰培养细菌敏感性及耐药性结果进行回顾性分析,记录、统计检验结果。分析社区获得性肺炎、医院获得性肺炎患者痰培养结果,对痰培养出细菌的药物敏感性及耐药性进行分析,回顾性分析经验性抗生素使用的规范性。结果1312例下呼吸道感染患者中1086例行痰涂片及痰培养检查,送检率82.8%。送检的1086例中痰涂片结果为革兰氏阳性菌450例,占41.4%；革兰氏阴性菌628例,占57.8%；酵母样菌50例(其中42例为合并其它细菌感染),占4.6%。痰培养结果中,500例无致病菌生长,占46.1%；痰液标本共分离病原菌586株,其中革兰阳性菌12株,占2.0%,革兰氏阴性菌574株,占98%,真菌50株,占4.6%。革兰阴性菌对氨苄西林、头孢唑林、阿莫西林/棒酸、复方磺胺甲基异恶唑的耐药性较高,对氨苄西林耐药率为44.1%,对头孢唑林耐药率为28.6%,对复方磺胺甲基异恶唑耐药率为28.4%,对阿莫西林/棒酸耐药率20.9%。社区获得性肺炎痰涂片以革兰氏阴性菌为主,部分痰培养无致病菌生长(与本院检验科痰培养仪器及方法条件有限有关)；医院内获得性肺炎痰涂片以革兰氏阴性菌为主,痰培养主要为肺炎克雷伯菌、阴沟肠杆菌和不动杆菌属为主,尤其ICU内以铜绿假单胞菌和鲍曼不动杆菌为主,且对所选抗生素耐药性较高,并呈现多重耐药性。真菌以白色念珠菌为主,对抗真菌药物普遍敏感。抗生素使用方面,普通病房经验性用药以第二代头孢菌素及青霉素/β-内酰胺酶抑制剂为主,ICU中轻症患者与普通病房抗生素使用基本相同,重症、机械通气支持呼吸及免疫力功能低下的患者以美洛培南为主,合并真菌者以伏立康唑为主。结论下呼吸道感染患者的病原菌种类较多,基层医院条件有限,痰培养对临床指导没有达到应有的水平。本组设计表现出社区获得性肺炎中革兰氏阳性菌为主,医院获得性肺炎以革兰阴性菌感染占大多数,ICU中以铜绿假单胞菌和鲍曼不动杆菌为主,耐药率较高且表现为多重耐药。经验性抗生素使用合理有效,本院普通病房细菌耐药率低,但ICU中细菌耐药率较高。
[Abstract]:Objective to investigate the composition of pathogens, drug sensitivity and drug resistance in patients with lower respiratory tract infection, and to summarize the effect of empirical antibiotic use in order to guide clinical experience antibiotic therapy in patients with lower respiratory tract infection. Reduce the incidence of drug-resistant bacteria. According to the results of drug sensitivity, antibiotics were used rationally to reduce the incidence of bacterial resistance in ICU ward. Participants and methods the sputum samples of 1312 patients with lower respiratory tract infection from March 2010 to March 2013 were analyzed retrospectively and the results of bacterial susceptibility and drug resistance were recorded. Statistical test results. The results of sputum culture in patients with community acquired pneumonia and hospital acquired pneumonia were analyzed. The drug sensitivity and drug resistance of sputum culture bacteria were analyzed. Results sputum smear and sputum culture examination were performed in 1086 of 1312 patients with lower respiratory tract infection. The results of sputum smear of 1086 cases were gram-positive bacteria (41.4%), Gram-negative bacteria (628 cases, 57.8%), yeast-like bacteria (42 cases were complicated with other bacterial infections) (4.6%). 586 strains of pathogenic bacteria were isolated from sputum samples, of which 12 strains were Gram-positive bacteria, 574 strains were Gram-negative bacteria, 98 strains were Gram-negative bacteria, and 50 strains were fungi, accounting for 4.6%. Gram-negative bacteria showed higher resistance to ampicillin, cefazolin, amoxicillin / koronic acid and compound sulfamethoxazole. The resistance rates to ampicillin, cefazolin, sulfamethoxazole and amoxicillin were 44.1, 28.6, 28.4 and 20.9 respectively. The sputum smears of community-acquired pneumonia were mainly Gram-negative bacteria, and some sputum culture did not cause the growth of pathogenic bacteria (related to the limited equipment and methods of sputum culture in our laboratory), and the hospital acquired pneumonia sputum smears were mainly Gram-negative bacteria. Sputum culture mainly consisted of Klebsiella pneumoniae, Enterobacter cloacae and Acinetobacter, especially Pseudomonas aeruginosa and Acinetobacter baumannii in ICU. Fungi are mainly Candida albicans and are generally sensitive to antifungal drugs. In the use of antibiotics, the second generation cephalosporin and penicillin / 尾 -lactamase inhibitor were used empirically in the general ward. The patients with mild disease in ICU were basically the same as those in the general ward. Mechanical ventilation supports malopenem in patients with low respiratory and immune function, and voleconazole in patients with fungi. Conclusion there are many kinds of pathogenic bacteria in patients with lower respiratory tract infection, the condition of basic hospital is limited, and the sputum culture does not reach the proper level for clinical instruction. The design showed that Gram-positive bacteria were the main bacteria in community-acquired pneumonia. Gram-negative bacilli were the major pathogens in hospital acquired pneumonia. Pseudomonas aeruginosa and Acinetobacter baumannii were the major pathogens in ICU. The drug resistance rate was high and multidrug resistance was found. The use of empirical antibiotics was reasonable and effective, the rate of bacterial resistance was low in our hospital, but the rate of bacterial resistance in ICU was higher.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563

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