肺部感染病原菌分布及耐药性监测

Distribution and Drug Resistance of Pathogens Causing Pulmonary Infection

目的探讨医院2006-2009年肺部感染患者病原菌的分布和对常用抗菌药物耐药情况,以指导临床合理使用抗菌药物。方法采用纸片扩散法对病原菌进行药敏试验,并对肠杆菌科细菌进行ESBLs检测,按CLSI2005年标准判定药敏结果 ,用WHONET5.3软件进行数据分析。结果 3822株临床分离病原菌中,革兰阴性杆菌占68.2%;肠杆菌科细菌中产ESBLs大肠埃希菌和肺炎克雷伯菌检出率分别为41.4%、43.3%,对头孢噻肟及头孢他啶的耐药率均较高,分别为100.0%、87.0%和100.0%、81.5%,产或非产ESBLs株对碳青酶烯类均高度敏感;非发酵革兰阴性杆菌中铜绿假单胞菌对头孢唑肟、头孢吡肟和头孢哌酮/舒巴坦的耐药率<20.0%;鲍氏不动杆菌对亚胺培南和头孢哌酮/舒巴坦的耐药率分别为14.5%和16.0%;嗜麦芽寡养单胞菌对亚胺培南耐药率达92.0%;临床分离真菌523株,主要以白色假丝酵母菌为主,对氟康唑仍有较高的敏感性,敏感率为98.3%,仅克柔假丝酵母菌对氟康唑敏感率低,为34.8%。结论临床常见病原菌已显示较高耐药比率,开展病原菌耐药性监测,对指导临床经验抗感染治疗时合理选择抗菌药物具有重要参考价值。

OBJECTIVE To investigate the distribution and antibiotic resistance profile of the pathogens isolated from clinics for pulmonary infection during 2006-2009 years.METHODS Kirby-Bauer method was used to conduct the susceptibility test and ESBLs detection.The susceptibility was tested by disk diffusion method recommended by CLSI 2005.The results were analyzed by WHONET5.3 software.RESULTS Of the 3822 clinical isolates,68.2% were Gram-negative bacillus.Among the Enterobacteriaceae,ESBLs-producing E.coli accounted for 41.4% and 43.3% in K.pneumoniae,the resistant rates of them to cefotaxim,ceftazidime were high,the resistant rates of E.coli and K.pneumoniae to cefotaxim,ceftazidime were 100.0%,87.1% and 100.0%,81.4%.ESBLs producing and non ESBLs-producing strains were highly susceptible to carbapenems.The resistance rates of P.aeruginosa to ceftizoxime,cefepime and cefoperazone/sulbactam were below 20.0%.A.baumanii were highly susceptible to imipenem and cefoperazone/sulbactam with the resistance rates 14.5% and 15.9%.The resistance rate of S.maltophilia to imipenem was 91.7%.The clinical isolated fungal isolates were 523 strains,most of them were Candida albicans,and they were highly susceptible to fluconazole with the sensitive rates 98.3%.Only Candida krusei were lowly susceptible,the susceptibility rate was 36.4%.CONCLUSION The common pathogens in clinics are with a high proportion,to develop the drug resistant surveillance has great importance for the rational selection of antibiotics.