下呼吸道感染病原菌分布及耐药性监测

Distribution of pathogens in lower respiratory tract infection and drug resistance

目的调查呼吸科感染病原菌种类的分布及耐药趋势。方法对2007年1月至2008年12月山西医科大学第一医院呼吸科住院患者痰标本中分离出的病原菌及其鉴定和药敏实验的结果进行分析。结果共分离病原菌1501株,革兰阴性菌841株(56.03%),以嗜血杆菌、铜绿假单胞菌、肺炎克雷伯菌、阴沟肠杆菌、鲍曼不动杆菌和大肠埃希菌多见;革兰阳性球菌291株(19.39%),其中肺炎链球菌、金黄色葡萄球菌、棒状杆菌多见;真菌369株(24.58%)。药敏结果:肺炎克雷伯菌、阴沟肠杆菌、鲍曼不动杆菌和大肠埃希菌对亚胺培南100%敏感,对头孢派酮/舒巴坦的敏感率>90%;铜绿假单胞菌对常见的抗生素均有不同程度的耐药;肺炎链球菌对青霉素的敏感率为43.75%;未发现耐万古霉素的金黄色葡萄球菌和肠球菌菌株。结论医院感染的耐药问题日趋严重,定期进行细菌耐药性监测,对指导临床合理应用抗菌药物,积极有效地控制医院感染具有重要意义。

Objective To investigate the distribution of infectious pathogens in respiratory disease department and analyze their drug resistance, provide evidence to guide clinical medication and control nosocomial infections. Methods The pathogens isolated from patients in our hospital from January 2007 to December 2008 were identified and the drug susceptibility tests were performed. Results A total of 1501 strains of pathogens were isolated, of which 841 were gram negative bacilli strains （56. 03% ）; 291 were gram positive coccus strains （19. 39% ）; 369 were fungus strains （24.58%）. Among the gram negative bacilli strains, the most common pathogens were Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterobacter cloacae, Escherichia coli, Acinetobacter baumannii and Haemophilus influenzae, and among the gram positive coccus strains, the most common pathogens were Streptococcus penumoniae, Staphylococcus aureus and microbacterium. The drug susceptibility test results indicated that Klebsiella pneumoniae, Enterobacter cloacae, Escherichia coli and Acinetobacter banmannii were 100% sensitive to imipenem and over 90% sensitive to cefperazone-sulbactam; Pseudomonas aeruginosa was resistant to common antibiotics at different degree. The sensitive rate of Streptococcus penumoniae to penicillin was 43. 75% ; no strains of Staphylococcus aureus and Enterococcus faecalis or Enterococcus faecium were found to be resistant to vancomycin. Conclusion The drug resistance of the nosocomial infection pathogens now is more serious. It＇s important to conduct the surveillance of pathogen drug resistance regularly for the rational use of antibiotics and effective control of nosocomial infections.