下呼吸道感染常见病原菌及药敏分析

Analysis of the bacteria isolated and the antibiotic resistance of lower respiratory tract infection

目的回顾分析院内下呼吸道感染病原菌的分布及耐药情况,为临床选用抗菌药物提供参考依据。方法收集住院下呼吸道感染患者痰标本分离的病原菌,采用纸片扩散法行药敏试验。结果分离出819株病原菌,其中革兰阴性杆菌574株,占70.1%,革兰阳性球菌154株,占18.8%,真菌91株,占11.1%。革兰阴性杆菌中前3位依次为:铜绿假单胞菌308株,占53.7%,鲍曼不动杆菌140株,占24.4%,大肠埃希菌56株,占9.8%;革兰阳性球菌中前3位为:金黄色葡萄球菌84株,占54.5%,溶血葡萄球菌42株,占27.3%,表皮葡萄球菌21株,占13.6%。耐药性分析:铜绿假单胞菌对头孢曲松耐药率最高,对阿米卡星、头孢吡肟、亚胺培南、美洛培南、哌拉西林/三唑巴坦耐药率较低。鲍曼不动杆菌对头孢曲松耐药率高,对阿米卡星、亚胺培南、美洛培南、哌拉西林/三唑巴坦耐药率低。大肠埃希菌对环丙沙星耐药率高,对阿米卡星、氨苄西林/舒巴坦、头孢他啶、亚胺培南、美洛培南、哌拉西林/三唑巴坦耐药率较低。结论革兰阴性杆菌是下呼吸道感染的常见病原菌,最常见为铜绿假单胞菌;药敏结果表明细菌耐药性较高,应加强病原菌检测及耐药性监测,合理使用抗菌药物。

Objective To review the distribution and drug resistance of pathogens in nosocomial lower respiratory tract infection to provide the reference for clinical use of antimicrobial agents.Methods Sputum samples were collected from hospitalized patients with lower respiratory tract infection.Pathogens were isolated from sputum and disc diffusion test was used to study the antimicrobial resistance.Results A total of 819 isolates were obtained,including Gram-negative bacteria 574（70.1%）,Gram-positive cocci 154（18.8%）and fungi 91（11.1%）.The top three Gram-negative bacilli were Pseudomonas aeruginosa（308 isolates,53.7%）,Acinetobacter baumannii（140 isolates,24.4%）and Escherichia coli（56 isolates,9.8%）.The top three Gram-positive cocci were Staphylococcus aureus（84 isolates,54.5%）,Staphylococcus haemolyticus（42 isolates,27.3%）and Staphylococcus epidermidis（21 isolates,13.6%）.Analysis of drug resistance showed high resistance rate of Pseudomonas aeruginosa to ceftriaxone,and low resistance rate to amikacin,cefepime,imipenem,meropenem,and piperacillin/tazobactam;high resistance rate of Acinetobacter baumannii to ceftriaxone,and low resistance rate to amikacin,imipenem,meropenem and piperacillin/tazobactam;high resistance rate of Escherichia coli to ciprofloxacin,and low resistance rate to amikacin,ampicillin/sulbactam,ceftazidime,imipenem,meropenem and piperacillin/tazobactam.Conclusion Gram-negative bacteria are the common pathogens of lower respiratory tract infections,Pseudomonas aeruginosa is the most common.High bacterial resistance found in susceptibility test indicates pathogen detection and drug resistance monitoring should be enhanced,antimicrobial agents should be rational used.This study will help the selection of antimicrobial drug in the treatment of lower respiratory tract infection