2005-2007年呼吸科病房病原菌的分布及耐药性变迁

Clinical Distribution of Pathogens and Antimicrobial Resistance in Respiratory Ward 2005-2007

目的分析医院呼吸科病房病原菌的分布及耐药性特点，为呼吸科临床合理使用抗菌药物提供依据。方法回顾性分析2005—2007年呼吸科病房送检的所有标本细菌培养和药物敏感试验结果。结果共分离菌株264株，革兰阳性菌68株（25．8％），革兰阴性菌165株（62．5％），真菌31株（11．7％）；耐甲氧西林金黄色葡萄球菌（MRSA）检出77．1％，3年中呈增加趋势；未发现耐万古霉素金黄色葡萄球菌和肠球菌；肺炎链球菌对青霉素的耐药率为44．4％～66．7％；肠杆菌科细菌和鲍氏不动杆菌对亚胺培南高度敏感；铜绿假单胞菌敏感率〉70．0％的药物依次为头孢哌酮／舒巴坦、阿米卡星、庆大霉素、哌拉西林／他唑巴坦、头孢他啶、头孢吡肟、头孢哌酮、亚胺培南。结论呼吸科病房临床分离菌符合近年来病原菌的变化趋势，病原菌以革兰阴性菌为主，病原菌的耐药日趋增高，对指导临床合理使用抗菌药物具有重要意义。

OBJECTIVE To analyze the pathogenic distribution and antimicrobial resistance in respiratory ward and provide the rational information to use antibiotics reasonably. METHODS All pathogens isolated from patients in a respiratory ward from 2005 to 2007 and drug susceptibility results were retrospectively analyzed. RESULTS Totally 264 strains of pathogenic bacteria were isolated, in which 68 strains of Gram-positive bacteria, 165 strains of Gram-negative bacteria and 31 strains of fungi. MRSA prevalence was 77.1 % and showed a trend of increase. No vancomycin-resistant Staphylococcus aureus or Enterococcus was detected. The resistance rate of Streptoccocus pneumoniae to penicillin, erythromyein and levofloxaein was 44.4-66.7%. Enterobacter and Acinetobacter baumannii showed stable susceptibility to imipenem. Pseudomonas aeruginosa strains were relatively susceptible to cefoperazone/sulbaetam, amikacin, gentamicin, piperacillin/tazobaetam, ceftazidine, cefepime, cefoperazone and imipenem. CONCLUSIONS The changes in pathogens and antibiotic resistance in the respiratory ward are consistent with the surveillance data in this country, Gram-negative bacteria are still the most common pathogens and the serious degree of bacterial drug resistance is increasing. Our data are useful for the guidance of rational use of antibiotics.