医院内获得性肺炎的病原菌分布及治疗

Distribution and Treatment of Pathogens in Hospital Acquired Pneumonia

目的了解医院内获得性肺炎（HAP）的病原菌分布和耐药情况，指导经验性治疗抗菌药物的临床应用。方法采用符合医院获得性肺炎病人痰标本分离的致病菌株，药敏试验采用K-B纸片扩散法，判断按NCCLS标准。结果HAP的病原菌分布以G杆菌为主，占76．36％，其中铜绿假单孢菌、大肠埃希氏菌、肺炎克雷伯菌占前三位，产超广谱β-内酰胺酶（ESBLs）的大肠埃希氏菌、肺炎克雷伯菌的检出率分别是38．09％、55．55％。耐甲氧西林金黄色葡萄球菌（MRSA），凝固酶阴性葡萄球菌（MRCONS）的检出率分别为71．43％、38．46％。结论医院感染菌的多重耐药给抗菌治疗带来困难，检测细菌分布及耐药性变化具有重要意义，对控制医院内感染，合理使用抗菌素十分重要。

Objective To study the distribution and the drug-resistance situation of bacteria isolated from in patients in order to guide the experienced application of antibacterial agents. Methods K-B text was applied for the antimicrobial susceptibility test form the sputum samples of patients with hospital acquired pneumonia （HAP） and the results were read based on National Committee for Clinical laboratory Standards （NCCLS）. Results The clinical isolates were mainly Gramnegative pathogens （76.36%） form 2003 to 2004, among which the top three were pseudomonas aeruginosa, Escherichia coli, and Klebsiella Pneumoniae. ESBLS positive rate were 38.09% of E.coli and 55.55% of Klebsiella pnenmoniae. 71.43% S.aureus and 38.46% MRCONS were resistance to oxacillin; Conclusions The multi-drug resistance of bacteria isolated from inpatients brings the difficulty to antibacterial treatment. Monitoring the distribution and change of the drug resistance of bacterium are important, and play the key role in controlling nosocomial infection and reasonably application of antibiotics.