2008年度某医院成人下呼吸道感染药敏结果及分析

Drug susceptibility in adult lower respiratory tract infection in 2008

目的通过对本院呼吸科、老年科送检的成人下呼吸道感染患者痰样本进行总结、分析，评估本院下呼吸道感染患者感染的病原体分布及对抗菌药物的耐药情况，为临床治疗选择抗菌药物提供参考意见。方法收集本院2008年1月-2008年12月呼吸科、老年科成人下呼吸道感染住院病人痰样本，进行常规细菌及真菌培养，分离菌株采用法国生物梅里埃公司生产的VrrEK～32全自动微生物鉴定仪，进行细菌鉴定及药敏试验。结果共送检痰样本1100例，培养分离出病原菌224株，其中G^＋56株（25．0％），G^-136株（60．7％），真菌32株（14．3％）。G^＋菌对青霉素类，第一代、第二代头孢菌普遍耐药（〉60％），对肛内酰胺类加抑酶复合制剂的耐药率较低（〈40％），对氟喹诺酮类、多西环素的耐药率中等（〈50％），对替考拉宁、万古霉素的耐药率为0；G^-菌对第一代、第二代头孢菌素普遍耐药（980％），对第三代、第四代头孢菌素的耐药率亦较高（〉60％），对氟喹诺酮类、氨基苷类（半合成类）、多西环素、β-内酰胺类加抑酶复合制剂的耐药率中等（〈60％），对碳青酶烯类、多黏菌素的耐药率为0。结论本院下呼吸道感染病原菌主要为条件致病菌，以G^-菌为主，真菌感染率较高，细菌耐药率普遍较高，临床医师应重视病原学检查和药敏监测，以便更合理选择和使用抗菌药物。

Objective To provide reference for clinical treatment of selection of antimicrobial agents by summarying and analyzing sputum samples and assessing the distribution and resistance of pathogens in patients with lower respiratory tract infectionpathogens from elderly subjects. Methods Bacterial and fungi were cultured, and identified , and susceptibility test was done with the pathogens in sputum samples from the patients with lower respiratory tract infection from elderly subjects from January to February in 2008. The separation was done by BioMerieux French company VITEK-32 automatic microbial identification device. Results A total of 1100 sputum samples were collected and 224 pathogens were separated . Among all the isolated strains, 56 strains （25.0%） were Gram-positive bacteria （G^＋ ）, 136 strains （60.7%） Gram-negative bacteria （G^-） and Fungi 32 strains （14. 3%）. G^- was generally resistant to penicillin-type, while cephalosporins Ⅰ and Ⅱ （〉60%） less resistant to β-1actam plus suppression of drug-resistant enzyme complex agents （〈40%）, and moderately resistant to fluoro quinolone, doxyeycline （〈50%）, and not resistant to teicoplanin, vancomycin resistance. G^- was generally resistant to eephalosporins Ⅰ and Ⅱ （80%）, highly resistant to cephalosporins Ⅲand Ⅳ（〉 60%）, and moderately resistant to fluoroquinolones, aminoglycosides （semisynthetic）, doxycycline, β-1actam plus inhibition enzyme complex （〈60%）, and not resistant to carbon green vinyl enzyme and polymyxin. Conclusion The pathogens are mainly opportunistic pathogens. G^- and fungi infection and bacterial drug resistance rate are relatively high. Clinicians should pay attention to etiology inspection and monitoring of drug sensitivity to select and apply the antimicrobial agents more reasonably.