痰标本中的病原菌分布及耐药性分析

Distribution of pathogens on sputum specimens and research of drug resistance

目的分析本院2004～2006年医院感染患者痰标本中病原菌的分布和耐药性,为临床合理使用抗生素提供参考依据。方法用TDR微生物分析仪做细菌的鉴定和药敏试验。产超广谱β-内酰胺酶(ESBLs)的检测用纸片法,耐甲氧西林葡萄球菌的检测用K-B法。结果医院感染患者痰液中最常见的致病菌为铜绿假单胞菌(15.2%～22.7%),大肠埃希菌(11.0%～14.8%),肺炎克雷伯菌(6.4%～9.8%),白假丝酵母菌(8.6%～25.4%),阴沟肠杆菌(4.6%～6.4%),金黄色葡萄球菌(3.7%～5.4%),表皮葡萄球菌(4.0%～6.7%)。大肠埃希菌、白假丝酵母菌、肠球菌有逐年升高趋势。耐药性结果显示大多数抗生素的耐药率逐年升高,多重耐药十分严重。大肠埃希菌和肺炎克雷伯菌产ESBLs的检出率为27.8%～45.9%和31.6%～52.2%;金黄色葡萄球菌和表皮葡萄球菌耐甲氧西林的检出率为33.3%～38.5.2%和41.7%～63.2%。结论下呼吸道感染病原菌菌谱是不断变化的,耐药问题日益严重,应加强抗生素的合理使用和采取有效的隔离措施以降低耐药率及多重耐药菌株的扩散。

Objective To conduct the retrospective analysis on the distribution and the drug resistance of pathogens in our hospital from 2004 to 2006, and to provide reference for the rational use of antimicrobial in clinic. Methods The bacteria and drug sensitivity were analyzed by TDR. ESBLs bacteria were isolated by paper mehod, MRS were isolated by K-B method. Results Major pathogens in sputa of the patients with nosocomial infection included Pseudomonas aerugmosa （ 15. 2 % - 22. 7 % ）, Candida albican （8. 6 % - 25.4 % ）, Escherichia coli （ 11.0 % - 14. 8 % ）, Klebsiella pneumoniae（6.4 % - 9.8 % ）, Staphylococcus aurens（3.7 % - 5.4 % ）, Staphylococcus epidermidis （4. 0 % - 6.7 % ）, Enterobacter cloacge （4.6 % - 6.4 % ）. The isolation rate of Escherichia coli, Candida albican, Enterococcus faecalis decreased year by year. The results of the drug resistance test showed that the resistant rates of most antimicrobial were increased every year and the multiple drug resistance to antibiotics was serious. The incidences of isolation rates to E. coli and K. pneumoniae were 27.8% -45.9 % and 31.6%- 52.2% respectively. The methicillin resistant rates of S. aureus and S. epidermidis were 33.3%- 38. 5% and 41.7%- 63.2% respectively. Conclusion Pathogens in LRTI changes frequently and the drug restance is more and more serious. It is important to enforce the rationl use of antimicrobial agents and take effective measures to reduce the resistant rates of bacteria and dissemination of multidrug resistant bacteria.