下呼吸道感染病原菌的变迁及耐药性分析

Pathogen Variance and Drug Resistance of Lower Respiratory Tract Infection

目的分析医院近3年下呼吸道感染病原菌的分布和病原菌耐药性的现状及变迁趋势，为医院感染控制和呼吸道感染合理用药提供帮助。方法常规方法培养分离下呼吸道标本病原菌，并对2006年6月～2009年6月下呼吸道感染病原菌的分布和耐药性进行回顾性统计分析。结果下呼吸道感染病例中，革兰阴性杆菌感染占58．9％，真菌感染占24．1％，革兰阳性球菌感染占17．0％；引起医院感染流行的产超广谱β-内酰胺酶的大肠埃希菌、肺炎克雷伯菌和耐甲氧西林金黄色葡萄球菌（MRSA）以较快的速度上升，分离出的病原菌对青霉素类和一、二、三代头孢类抗菌药物的耐药性逐年增长。结论下呼吸道感染病原菌的构成不断变迁，耐药率不断增高，医院应加强感染病例的病原菌分离和耐药性检测、监控；有针对性地选用抗菌药物，提高经验用药的有效性。

OBJECTIVE To investigate the current situation and variation trend in our hospital of the distribution of pathogen of lower respiratory tract infections and drug resistance of the past three years, in order to provide evidence for rational drug usage and infection control in hospital. METHODS By using routine method to investigate the specimens from Jun 2006 to Jun 2009, pathogens were isolated and identifided. The constituent ratio of pathogen and drug resistance rates were caeulated according to statistical analysis. RESULTS The isolated rate of Gram-negative bacilli, fungi and Gram-positive cocci was 58. 9%, 24. 1% and 17.0%, respectively; the extended-spectrum β-lactamases-producing Escherichia coli, KZebsiella pneurnoniae and meticillin-resistant Staphylococcus aureus （MRSA） were kept increasing. Drug resistance of pathogens was rising year by year on penicillins, and first, second and third-generation cephalosporins. CONCLUSIONS Since the constituent ratio varys constantly and the rate of drug resistance increase continuously, a dynamic monitoring of drug susceptibility to pathogen is required. Referring to the outcome and data of this study, it could lead a better choice on antibiotics, take precautions against local epidemic infection and vigorous growth of drug resistance.