内科肺部感染住院患者革兰阴性杆菌菌种分布及耐药性分析

Distribution and drug resistance of gram-negative bacilli isolated from internal medicine patients with pneumonia

目的 了解某院内科住院患者肺部感染革兰阴性(G-)杆菌的菌种分布及耐药情况,以利于临床合理选用抗菌药物。方法 收集下呼吸道标本,采用VITEK 32全自动微生物分析仪鉴定细菌,并做药物敏感(药敏)试验。结果 共分离细菌6 6 8株,其中G-杆菌4 19株(6 2 .72 % ) ,包括铜绿假单胞菌12 1株(2 8.88% )、肺炎克雷伯菌88株(2 1.0 0 % )、嗜麦芽窄食单胞菌5 4株(12 .89% )、鲍曼不动杆菌4 6株(10 .98% )、大肠埃希菌32株(7.6 4 % )、阴沟肠杆菌2 8株(6 .6 8% )、其他菌株5 0株(11.93% )。铜绿假单胞菌对哌拉西林/他唑巴坦的耐药率最低(14 .88% ) ,其次为妥布霉素(19.0 0 % ) ;肺炎克雷伯菌和大肠埃希菌对亚胺培南耐药率最低(0 ) ,其次为头孢替坦(分别为9.0 9%和3.13% ) ;鲍曼不动杆菌对哌拉西林/他唑巴坦和妥布霉素耐药率最低(分别为32 .6 0 %和30 .4 3% ) ;嗜麦芽窄食单胞菌对哌拉西林/他唑巴坦和头孢吡肟耐药率最低(分别为3.70 %～16 .6 7% ) ;阴沟肠杆菌对亚胺培南和头孢吡肟耐药率最低(分别为0和2 1.4 3% )。结论 G-杆菌为该院内科住院患者肺部感染的主要病原菌,各分离菌多重耐药现象严重,临床应依据病原学检查合理使用抗菌药物。

Objective To study the distribution and drug resistance of gram-negative (G -) bacilli isolated from internal medicine patients with pneumonia and improve rational usage of antimicrobial agents in clinic. Methods Lower respiratory tract samples were collected, bacterial identification and antimicrobial susceptibility tests were done by automatic microbial analyzer. Results Six hundred and sixty-eight bacteria strains were isolated, 419 ( 62.72% ) were G - bacilli, 121 strains ( 28.88% ) of which were Pseudomonas aeruginosa, 88 ( 21.00% ) were Klebsiella pneumoniae, 54 (12.89%) were Stenotrophomonas maltophilia, 46 ( 10.98% ) were Acinetobacter baumannii, 32 ( 7.64% ) were Escherichia coli, 28 ( 6.68% ) were Enterobacter cloacae, 50 ( 11.93% ) were the other strains. Pseudomonas aeruginosa had the lowest resistant rate to piperacillin/tazobactam and tobramycin ( 14.88% and 19.00% , respectively); Klebsiella pneumoniae and Escherichia coli had the lowest resistant rate to imipenem (0); Acinetobacter baumannii had the lowest resistant rate to piperacillin/tazobactam and tobramycin ( 32.60% and 30.43% , respectively); Stenotrophomonas maltophilia had the lowest resistant rate to piperacillin/tazobactam and cefepime ( 3.70% and 16.67% , respectively); Enterobacter cloacae had the lowest resistant rate to imipenem and cefepime (0 and 21.43% , respectively). Conclusion G - bacilli were the main bacteria in lung infection in patients who were hospitalized in the internal medicine department in this hospital, multiple drug resistance of the isolates was severe. Clinical rational antimicrobial application must depend on antimicrobial susceptibility test.