医院住院患者下呼吸道感染的病原菌分布与耐药性研究

Pathogens distribution and drug resistance in lower respiratory tract infection in hospitalized patients

目的了解我院下呼吸道感染住院患者的病原菌群的基本构成及其耐药性,为临床合理用药提供依据。方法对我院2006年1月至2009年12月住院患者的下呼吸道感染患者痰菌培养及药敏结果进行回顾性统计分析。结果本组标本共检出病原菌2 133株,其中革兰阴性杆菌1 032株(48.4%),革兰阳性菌464株(21.8%),真菌637株(29.9%)。耐甲氧西林金黄色葡萄球菌株的检出呈上升趋势,达77.4%;超广谱β-内酰胺酶(ESBLs)在大肠埃希菌和克雷伯菌属中的总检出率分别59.1%和32.6%。革兰阳性球菌中万古霉素和替考拉宁的抗菌活性最强。肠杆菌科细菌对碳青霉烯类仍高度敏感,非发酵革兰阴性杆菌对头孢哌酮/舒巴坦的耐药率最低。结论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 pathogenic bacteria and antibiotic resistance from the patients with lower respiratory tract infection in local region to help reasonably utilize antibiotics.Methods Retrospective analysis was made on the pathogens which were isolated from the sputa of the hospitalized patients with lower respiratory tract infection from January 2006 to December 2009 and their drug susceptibility results were discussed.Results Totally 2 133 strains of clinical isolates were identified,the isolated rates of gram-negative bacilli,gram-positive cocci and fungi were 1 032 strains（48.4%）,464 strains（21.8%） and 637 strains（29.9%） respectively.Staphylococcus aureus was still on the rise,accounted for 77.4%,the ESBLs-producing rate of E.coli strains and K.pneumoniae strains accounted for 59.1% and 32.6% respectively.Vancomycin and teicoplanin were the most potent antimicrobial agents against gram-positive cocci.Strains of Enterobacteriaceae were still highly susceptible to imipenem and meropenem.The resistance rates of non-fermentative gram-negative organisms to cefoperazone-sulbactam were the lowest among all the drugs tested.Conclusion It is important to conduct the surveillance of pathogen drug resistance regularly for the rational use of antibiotics and effective control of nosocomial infections.