肺部感染病原菌分布及耐药性分析

Analysis on the common pathogen distribution and bacterial resistance of clinical pulmonary infection

目的了解北京中医药大学第三附属医院患者肺部感染的病原菌分布特点及耐药特征,为临床合理使用抗生素提供依据。方法对该医院2010年5月～2011年7月临床送检痰样本分离鉴定,采用纸片扩散法对病原菌进行药敏试验,结果遵照CLSI M100-S20,用WHONET 5.5软件进行数据分析。结果分离出750株病原菌,革兰阴性杆菌531株,占70.80%;革兰阳性球菌92株,占12.27%;真菌分离127株,占16.93%。肠杆菌科细菌对亚胺培南和美罗培南有较高敏感性。非发酵革兰阴性杆菌中铜绿假单胞菌对亚胺培南和美罗培南耐药率为48.31%和45.24%,对阿米卡星、头孢哌酮/舒巴坦、头孢他啶、头孢吡肟较为敏感,耐药率在18.68%～25.14%之间。鲍曼不动杆菌对亚胺培南和美罗培南耐药率为70.71%和74.31%。金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌占66.67%,金黄色葡萄球菌对万古霉素100%敏感,对氯霉素和复方磺胺甲噁唑的耐药率分别为5.00%和7.59%。结论临床分离病原菌耐药性呈上升趋势,开展耐药性监测,对指导临床合理用药具有重要意义。

Objective Research on the distribution and bacterial resistance of clinical pulmonary infection so as to guide clinical use of antimicrobial agents.Methods Pathogens were isolated from the clinics for pulmonary infection during May 2010 to July 2011.Kirby-Bauer method was used to conduct the drug susceptibility test.Results were analyzed according to CLSI M100-S20 and analyzed by Whonet5.5.Results 750 pathogens were isolated,with which 70.80%（531strains） was gram negative bacillus,12.27% was gram positive bacteria（92 strains）,16.93% was fungus（127 strains）.Strains of enterobacteriaceae were still highly susceptible to imipenem and meropenem.The resistance rates of P.aeruginosa to imipenem and meropenem were 48.31% and 45.24%,while the resistance rates of P.aeruginosa to amikacin,cefoperazone/sulbactam,ceftazidime,cefepime were between 18.68% to 25.14%.The resistance rates of A.abaumanii to imipenem and meropenem were 70.71% and 74.31%.Among the Staphylococcus aureus,methicillin-resistant Staphylococcus aureus（MRSA） accounted for 66.7%,the sensitive rates of S.aureus to vancomycin were 100%,the resistance rates of S.aureus to chloramphenicol and sulfamethoxazole-trimethoprim were 5.00% and 7.59%.Conclusions Bacterial resistance to antibiotics is increasing.It is important to develop surveillance of bacterial resistance for the selection of antibiotics.