呼吸科病房下呼吸道感染病原菌分布及药敏现状

Antibiotic Susceptibility of Clinical Isolates from Lower Respiratory Tract Infection Patients in Respiratory Ward

目的了解医院呼吸科病房住院患者下呼吸道感染病原菌分布变迁、与肺部基础疾病的关系以及药物敏感情况。方法收集2003年1月-2007年12月医院呼吸病房下呼吸道感染1428例住院患者痰菌(或纤维支气管镜吸取分泌物)培养1529株阳性标本结果进行回顾性统计分析。结果1529株病原菌中,革兰阴性杆菌1326株(86.7%),革兰阳性球菌203株(13.3%);肺部基础疾病组较无肺部基础疾病组革兰阴性杆菌感染率高,而革兰阳性球菌感染率低;嗜血菌属对大观霉素、多西环素和第三代头孢菌素敏感;铜绿假单胞菌和鲍氏不动杆菌对美罗培南、头孢哌酮/舒巴坦、头孢吡肟敏感;肺炎克雷伯菌和大肠埃希菌对美罗培南、头孢哌酮/舒巴坦、阿米卡星敏感;表皮葡萄球菌、金黄色葡萄球菌和肺炎链球菌对阿奇霉素、红霉素、青霉素敏感率均较低,葡萄球菌属对万古霉素均敏感;肺炎链球菌对美罗培南、左氧氟沙星、头孢唑林、万古霉素敏感性好。结论下呼吸道感染以革兰阴性杆菌感染为主,且多发于存在肺部基础疾病的患者,常见病原菌耐药现象较严重,临床上注意合理应用抗菌药物。

OBJECTIVE To investigate the pathogenic bacteria distribution and susceptibility of lower respiratory tract infection in patients in our respiratory ward. METHODS All the clinical isolates from sputum or secretion of lower respiratory tract from 2003 to 2007 were analyzed retrospectively. RESULTS A total of 1529 clinical isolates were collected, including 1326 strains of Gram-negative bacilli （86. 7%） and 203 strains of Gram positive cocci （13.3%）. The proportion of Gram-negative bacilli was higher in lung underlying diseases group when compared with non-lung underlying diseases. Haemophilus parainfluenzae and H. influenzae were susceptible to spectinonycin, doxycycline and third-generation cephalosporins. Pseudomonas aeruginosa and Acinetobacter baumanni were susceptible to meropenem, cefoperazone/sulbactam and cefepime. Klebsiella pneumoniae and Escherichia coli were susceptible to meropenem, cefoperazone/sulbactam and amikacin. The major Gram-positive isolates were highly resistant to azithromycin, erythromycin, penicillin. All Staphylococcus aureus isolates were susceptible to vancomyein. Streptococcus pneurnoniae isolates were highly susceptible to meropenem, levofloxacin, cefazolin and vancomycin. CONCLUSIONS Infection caused by Gram negative bacilli are predominant in lower respiratory tract infection patients, especially in the patients with lung underlying diseases. Antibiotics resistance of some pathogens become increasingly severe. Therefore, the rational use of antibiotics is important for the containment of bacterial resistance.