肺部感染病原菌分布及耐药性分析

Analysis on the pathogen distribution and bacterial resistance of the clinical pulmonary infection

目的了解我院肺部感染患者的病原菌分布特点及耐药特征,为临床合理使用抗菌药物提供依据.方法对我医院2010年5月至2011年7月临床送检痰标本进行分离鉴定,采用纸片扩散法对病原菌进行药敏试验,用WHONET 5.5软件进行数据分析.结果分离出750株病原菌,革兰阴性杆菌531株,占70.8%;革兰阳性球菌92株,占12.3%;真菌127株,占16.9%.铜绿假单胞菌对阿米卡星、头孢哌酮/舒巴坦、头孢他啶、头孢吡肟较为敏感,耐药率在18.7%~25.1%之间,对氨苄西林、头孢唑啉、头孢呋辛、头孢西丁耐药率均达90.0%以上.鲍曼不动杆菌对所选抗生素耐药率均大于60.0%.肠杆菌科细菌对碳氢霉烯类抗生素如亚胺培南耐药率较低(5.2%,0.0%),对氨苄西林(98.6%,90.6%)、头孢唑啉(56.9%,70.3%)已经出现较高的耐药率.金黄色葡萄球菌(Staphylococcus aureus,SA)中耐甲氧西林金黄色葡萄球菌占66.7%,SA对万古霉素100%敏感,对氯霉素和复方新诺明的耐药率分别为5.0%和7.6%.结论临床分离病原菌耐药性呈上升趋势,开展耐药性监测,对指导临床合理用药具有重要意义.

Objective To research the distribution and drug resistance of the clinical pulmonary infection and guide antimicrobial agents using in clinical.Methods Pathogenic bacteria were isolated from the clinical sputum samples of pulmonary infection patients during May 2010 to July 2011.Kirby-Bauer method was used to do the drug sensitivity test.Results were analyzed by WHONET 5.5.Results 750 strains were isolated,with 531 strains of gram negative bacillus,accounted for 70.8%,92 strains of gram positive coccus,accounted for 12.3%,and 127 strains of fungus,accounted for 16.9%.The drug resistance of Pse udomonas aeruginosa to amikacin,cefoperazone/sulbactam,ceftazidimne and cefepime were in between 18.7%to 25.1%.While the drug resistance of Pse udomonas aeruginosa to ampicillin,cephazolin,cefuroxime,cefoxitin were all above 90.0%.The drug resistance of A cine tobacter baumannii to selected antibiotics were all above 60.0%.Enterobacteriaceae bacteria had low drug resistance to carbapenems antibiotics such as imipenem(5.2%,0.0%),but had high drug resistance to ampillin(98.6%,90.6%)and cephazolin(56.9%,70.3%).Among the Staphylococ cus aureus(SA),methicillin-resistant Staphylococcus cwureus accounted for 66.7%,the sensitive rates of SA to vancomycin were 100%,the resistance rates of SA to chloramphenicol and sulfamethoxazole-trimethoprim were 5.0%and 7.6%.Conclusion Bacterial resistance is increasing in clinical,to develop monitoring of drug resistance is important to the selection of antibiotics.