医院获得性下呼吸道感染病原菌分布及药物敏感性分析

Drug sensitivity and Distribution of Pathogenic Bacteria of Nosocomial Infection in Lower Respiratory Tract

目的了解医院获得性下呼吸道感染患者的病原菌分布,并分析其对抗生素的敏感性和耐药性特点,为临床用药提供参考。方法对2006年1月~2007年12月医院获得性下呼吸道感染患者合格痰标本进行细菌学培养,用API细菌鉴定及ATB药敏分析系统,进行菌株的鉴定与药物敏感性检测。结果共分离到470株致病菌,其中革兰阴性菌341株(72.5%),依次为铜绿假单胞菌129株(27.4%)、鲍曼不动杆菌74株(15.7%)、肺炎克雷伯菌40株(8.5%)、大肠埃希菌37株(7.9%)、嗜麦芽窄食单胞菌29株(6.2%);真菌91株(19.4%),以白色假丝酵母菌为主;革兰阳性菌38株(8.1%),以金黄色葡萄球菌和表皮葡萄球菌为主。药敏方面,铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌及大肠埃希菌对美洛培南和亚胺培南敏感性最高,嗜麦芽窄食单胞菌以复方新诺明最高;金黄色葡萄球菌与表皮葡萄球菌对万古霉素最敏感;白色假丝酵母菌对两性霉素B、5-氟胞嘧啶、氟康唑及伊曲康唑耐药性低。结论医院下呼吸道感染以革兰阴性杆菌为主,真菌感染日渐增加,不同病原菌对抗生素的敏感性和耐药性差异较大,应根据药敏结果选择抗菌药物。

Objective To study drug sensitivity or resistance and distribution of nosocomial infectious bacteria in lower respiratory tract among inpatients and use the experience for reference of clinical application. Methods Bacterial culture of the qualified sputum sample of patients who were admitted from Jan 2006 to Dec 2007 was done. The bacteria identification and drug sensitivity tests were done by API and ATB system. Results Totally 470 strains of bacteria were isolated, the dominant were Gram-negative bacilli (72.5%). Among them, the Pseudomonas aeruginosa was 27.4%, the Acinetobacter baumannii was 15.7%, the Klebsiella pneumoniae was 8.5%, the Escherichia coli was 7.9%, the Stenotrophomonas maltophilia was 6.2%, and the others were 6.8%. The second pathogens were fungi (19.4%). The Gram-positive bacteria were the lowest ones (8.1%) . The results of drug sensitivity tests indicated, the meropenem and imipenem were the most sensitive for Gram-negative bacilli except the Stenotrophomonas maltophilia. and for the Stenotrophomonas maltophilia, the highest was sulfamethoxazole-trimethoprim. The vancomycin was the most sensitive for the Staphylococcus aureus and the Staphylococcus epidermidis. The S. albicans was lowly resistant to antifungal agents. Conclusions The dominant pathogenic bacteria of nosocomial infection in lower respiratory tract in our hospital are Gram-negative bacteria. For the same antimicrobial agent, different bacteria have a different sensitivity. We should select the antibiotic according to the results of drug sensitivity test.