呼吸病房感染病原菌的分布及耐药性分析

Distribution of infective bacteria in respiratory ward and analysis on drug resistance in 2009

[目的]了解呼吸病房感染的病原菌分布情况,并且对病原菌对抗菌药物的耐药情况进行分析。[方法]对大连医科大学附属第一医院2009年呼吸病房患者痰标本进行培养鉴定及药敏试验,同时检测超广谱β内酰胺酶(extended spectrumβlactamases,ESBLs)及耐甲氧西林葡萄球菌(methicillin-resistant staphylococcus,MRS)。[结果]呼吸病房感染以革兰氏阴性菌为主,占79.29%,真菌感染次之,占11.62%,革兰氏阳性菌仅占9.09%。感染的革兰氏阴性杆菌中,以肺炎克雷伯菌和铜绿假单胞菌为主,各占23.74%、23.23%。在20株产ESBLs的菌株中有15株为肺炎克雷伯菌;5株为大肠埃希氏菌。产ESBLs的菌株中亚胺培南、美洛培南、头孢哌酮/舒巴坦的耐药率均为0。铜绿假单胞菌株中,头孢派酮/舒巴坦的耐药率最低。17株葡萄球菌中MRS有16株,占94.12%。万古霉素的耐药率为0。真菌感染以白色假丝酵母菌为主。5-胞嘧啶、两性霉素B的敏感率均为100%。[结论]2009年呼吸病房感染病原菌以革兰氏阴性菌为主,ESBLs及MRS耐药菌株的比例较高,真菌感染的比率较高。实验室及临床均应给予足够的重视,加强抗生素的合理使用。

[Objective] To understand the distribution of infective bacteria in patients in the respiratory ward at the hospital in 2009,and analysis on drug resistance.[Methods] The sputum specimens from the patients in respiratory ward in 2009 were cultured and identified,and then the susceptibility test was performed.At the same time,the extended spectrum β lactamases（ESBLs） and the methicillin-resistant staphylococcus（MRS） were detected.[Results] The main infective bacteria in the patients in 2009 were Gram-negative bacteria（79.29%）.The next was fungi（11.62%）.And then it was Gram-positive bacteria（9.09%）.The most common strains were Klebsiells pneumonia（23.74%） and Pseudomonas aeruginosa（23.23%）.Twenty strains of ESBLs were isolated.Fifteen of them were Klebsiells pneumonia and five strains were Escherichiacoli.The resistance rates of imipenem,meropenem and cefoperazone/sulbactam were zero.The resistance rate of cefoperazone/sulbactam was lowest in the Pseudomonas aeruginosa strains.Seventeen strains of staphylococci were isolated,and 16 strains of MRS were isolated（94.12%）.The resistance rate of vancomycin was zero.The main fungi were Candida albicans.The sensitive rates of 5-Cytosine and Amphotericin B were 100%.[Conclusion] The main infective bacteria in respiratory ward in 2009 are Gram-negative bacteria.The isolated rates of ESBLs and MRS are high.The rate of fungous infection is high.The results are important for clinical practitioners to use antibiotics more carefully.