下呼吸道感染患者的病原菌分布及耐药性监测

Distribution of pathogens causing lower respiratory tract infection and drug resistance monitoring

目的回顾性分析医院下呼吸道感染患者病原菌的分布及耐药性,为临床合理选用抗菌药物、及时有效的救治患者提供科学依据。方法统计医院各科2009年9月-2010年9月送检痰标本所分离病原菌的分布及其耐药性,采用WHONET5.4软件对结果进行分析。结果住院患者送检痰标本1836份,其中阳性标本1203株,阳性率65.5%;1203株阳性标本病原菌中,革兰阴性菌807株占67.1%,革兰阳性菌255株占21.2%,真菌141株占11.7%,位列前3位的病原菌依次为肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌,分别占17.2%、13.6%、13.2%;革兰阴性杆菌中耐药率较低的药物有亚胺培南,耐药率为9.7%～19.5%,头孢哌酮/舒巴坦耐药率为1.9%～12.2%,非发酵菌的耐药性要比肠杆菌科的耐药性要强;革兰阳性球菌对头孢吡肟、头孢噻肟的耐药率<25.0%,未检出耐万古霉素葡萄球菌。结论医院下呼吸道感染病原菌主要以革兰阴性杆菌为主,病原菌耐药率普遍较高,应引起临床医师与医院感染工作人员的高度重视。

OBJECTIVE To retrospectively analyze the distribution and antibiotic resistance of the pathogens in hospitalized patients with lower respiratory tract infection, provides a scientific basis for rational use of antimicrobial drugs for clinical, timely and effective treatment of patients. METHODS The distribution of isolated pathogens and drug resistance in sections of our hospital from Sep 2009 to Sep 2010 were counted, and the results of sputum specimens were analyzed by the WHONETS. 4 software. RESULTS In this period,1836 sputum samples of hospitalized patients were censored. There were 1203 positive samples, the positive rate was 65.5 %. In 1203 positive samples pathogens, Gram-negative bacteria was 807 （67. 1%）, Gram-positive bacteria were 255 （21.2%）, fungi were 141 （11.7%）. Reber bacteria （17.2%）, Pseudornonas aeruginosa （13.6%）, Escherichia coli （13.2%） were the top three pathogens. The results of the major pathogen resistance showed that drugs with low resistant rates were imipenem （9.7%-19.5 % ）, cefoperazone/sulbactam （1.9 %- 12.2% ）, non-fermenta- tive bacteria resistance was stronger than that of Enterobacteriaceae in Gram-negative bacilli; the resistance rate of Gram-positive cocci towards cefepime, cefotaxime was less than 25. 0%, strains of Staphylococcus aureus resistant to vancomycin were not detected. CONCLUSION The pathogens in lower respiratory tract infection are mainly Gram-negative bacilli, and bacteria resistance rate is rather high, which clinicians should pay attention to.