病原菌耐药性检测结果在下呼吸道感染治疗中价值的评价

Evaluation of Bacterial Drug Resistance Detection in Lower Respiratory Tract Infection Therapy

目的评价病原菌耐药性检测结果在下呼吸道感染治疗中的价值。方法统计下呼吸道感染住院患者痰标本的培养结果,了解病原菌菌种分布及其耐药状况;回顾调查近期该类患者的临床资料及培养送检率、阳性率、抗菌药物使用情况。结果下呼吸道感染住院患者痰液培养的送检率为67.8%,病原菌阳性率为55.9%;菌种分布以革兰阴性菌为主,占82.39%,革兰阳性菌占14.18%;不同病原菌对常用抗菌药物呈现不同程度的耐药,肠杆菌科细菌、非发酵菌对氟喹诺酮类抗菌药物环丙沙星的耐药率分别为47.8%、34.8%,对哌拉西林/他唑巴坦的耐药率分别为31.5%、44.7%;金黄色葡萄球菌对氟喹诺酮类抗菌药物左氧氟沙星的耐药率为63.9%。结论下呼吸道感染病原菌对常用抗菌药物耐药率较高,临床治疗仍以经验用药为主,对下呼吸道感染治疗中抗菌药物选择的作用不明显。

OBJECTIVE To evaluate bacterial drug resistance detection value in lower respiratory tract infection treatment. METHODS The data of distribution and antimicrobial resistance of clinical strains in sputum samples in patients with lower respiratory tract infection within some periods were collected and analyzed by WHONET software. Meanwhile, the delivery rates and detection positive rates of clinical species and antibiotics application status in clinic were retrospectively analyzed. RESULTS The delivery rates and detection positive rates of clinical species in patients with lower respiratory tract infection within some periods were 67. 8% and 55. 9%, respectively. The proportion of Gram-negative bacilli and Gram-positive cocci was 82. 39G and 14. 18%, respectively. Different drug resistance was displayed in different pathogenic bacteria. Resistant rate of Enterobacteriaceae bacteria and non-ferment bacteria against ciprofloxacin and piperacillin/tazohactam was 47.8%, 34.8% and 31. 5%, 44. 7%, respectively and resistant rate of S. aureus against levofloxacin was 63. 9%. CONCLUSIONS Although the pathogenic bacteria in patients with lower respiratory tract infection show higher drug resistance to general antibiotics, most of patients with lower respiratory tract infection are treated according to clinical experience of doctors, not based on the results of bacterial culture and antimicrobial susceptibility test. Therefore, the results of bacterial culture and antimicrohial susceptibility test do not play a proper role to direct anti-infective therapy in clinic.