2006年南京医大一附院下呼吸道感染病原菌分布和耐药性分析

Analysis of pathogen distribution and resistance in lower respiratory tract infections from the First Affiliated Hospital of Nanjing Medical University in 2006

目的了解我院2006年痰培养阳性标本病原菌分布和耐药性规律。方法采用API鉴定系统鉴定细菌及真菌;纸片扩散法测定细菌药物敏感性,Rosco纸片法测定真菌药物敏感性;WHONET 5.4软件进行统计分析。结果2006年我院痰培养阳性率为18.8%;阳性标本主要分布在老年医学科、重症监护病房、呼吸内科及急诊病房等;检出率最高的病原菌是铜绿假单胞菌,占阳性标本的26%,其次是不动杆菌(12.8%)和肺炎克雷伯菌(11.6%);耐药性分析结果显示,葡萄球菌属未发现万古霉素耐药株,但对其它多种抗菌药物耐药;肠杆菌科细菌对美洛培南、亚胺培南、头孢哌酮/舒巴坦和哌拉西林/三唑巴坦较敏感;非发酵菌中,铜绿假单胞菌和嗜麦芽寡养假单胞菌对大部分抗菌药物耐药,不动杆菌对美洛培南、亚胺培南和头孢哌酮/舒巴坦较敏感。结论下呼吸道感染病原菌对多种抗菌药物耐药率较高,应引起重视,合理选择抗菌药物。

Objective To analyze the pathogen distribution and resistance pattern of the positive clinical sputum specimens in our hospital. Methods The bacteria and fungi were identified by API system; the susceptibility of antimicrobial and antifungal agents was tested by KB and Rosco disk diffusion method; the data were analyzed by WHONET 5.4 software. Results In 2006, the positive rate of sputum specimens was 18.8% in our hospital. The majority of the positive specimens were distributed among geratology division, intensive care unit （ICU）, respiratory division and emergency division. The pathogen of the highest isolating rate was Pseudomonas aeruginosa, accounting for 26 %, the next was Acinetobacter species （12.8 %） as well as Klebsiella pneumoniae （11.6%）. In view of the resistance, no Staphylococcus species resistant to vancomycin, while they were resistant to many other antimicrobial agents. Gram-negative Enterobactericaeae were fairly sensitive to carbapenems, cefoperazone/sulbactam and piperacillin/tazobactam. Among Nonfermenters, P. aeruginosa and Stenotrophmomas maltophilia were resistant to the most antimicrobial agents while Acinetobacter were comparatively sensitive to carbapenems and cefoperazone/sulbactam. Conclusion The pathogens in lower respiratory tract infections have a high resistance rate to many antimicrobial agents. In view of the seriousness of this problem, we must lay enough emphasis on it and select antimicrobial agents rationally.