下呼吸道感染分离菌分布特点及耐药性分析

Distribution and drug resistance of isolated bacteria causing lower respiratory tract infections

目的了解医院2011年下呼吸道感染病原菌分布特点及耐药性,为临床合理用药提供参考。方法对医院2011年痰标本检出病原菌及耐药性进行统计分析。结果 2011年1-12月检验科住院部患者的1471份痰标本,培养分离出369株病原菌;下呼吸道感染分离菌以革兰阴性菌为主,占57.2%,其次是真菌和革兰阳性球菌,分别占28.2%和13.6%;肠杆菌科细菌对亚胺培南高度敏感,无耐药菌株出现;其次对头孢哌酮/他唑巴坦、哌拉西林/他唑巴坦和阿米卡星有较好的敏感性;鲍氏不动杆菌仅对头孢哌酮/他唑巴坦敏感性较好,敏感率为82.1%;其次为亚胺培南、哌拉西林/他唑巴坦和米诺环素,敏感率分别为53.9%、46.2%和43.6%;铜绿假单胞菌耐药较严重,仅对亚胺培南、头孢哌酮/他唑巴坦、哌拉西林/他唑巴坦有较好的敏感性,敏感率分别为85.1%、61.2%、59.7%;革兰阳性球菌对万古霉素敏感率100.0%,无耐药菌株出现;金黄色葡萄球菌除对万古霉素完全敏感外对磺胺甲噁唑/甲氧苄啶敏感性较好为72.0%,对青霉素类和头孢类耐药性严重;肺炎链球菌除对万古霉素完全敏感外对左氧氟沙星有较高的敏感性,敏感率为96.0%,其他常用抗菌药物耐药率均>80.0%。结论医院下呼吸道感染病原菌以革兰阴性杆菌为主,对多种抗菌药物的耐药率较高,多药耐药情况严重;真菌感染有上升趋势,临床应加强微生物学检查,合理使用抗菌药物,避免菌群失调。

OBJECTIVE To investigate the distribution and drug resistance of the pathogens causing lower respiratory tract infections in 2011 so as to provide reference for rational use of drugs.METHODS The distribution and drug resistance of the pathogenic bacteria isolated from the sputum specimens in 2011 were statistically analyzed.RESULTS Of 1471 sputum specimens tested in the clinical laboratory department from Jan to Dec 2011,totally 369 strains of pathogens were cultured and isolated.The predominant bacteria causing lower respiratory tract infections were the gram-negative bacteria（57.2%）,followed by the fungi（28.2%） and the gram-positive cocci（13.6%）.Enterobacteriaceae were highly sensitive to imipenem,there were no drug resistant strains,the strains were sensitive to cefoperazone/tazobactam,piperacillin/tazobactam and amikacin.The drug susceptibility rates of Acinetobacter baumannii to cefoperazone/tazobactam,imipenem、piperacillin/tazobactam and minocycline were 82.1%,53.9%,46.2%,and 43.6%,respectively.Pseudomonas aeruginosa was seriously drug resistant,the drug susceptibility rates to imipenem,cefoperazone/tazobactam,piperacillin/tazobactam were 85.1%,61.2%,and 59.7%,respectively.The gram-positive bacteria were 100.0% sensitive to vancomycin,and no drug resistant strains emerged.The drug susceptibility rate of Staphylococcus aureus to sulfamethoxazole/trimethoprim was 72.0% except 100.0% sensitivity to vancomycin,the strains were seriously resistant to penicillins and cephalosporins.Streptococcus pneumoniae was completely sensitive to vancomycin and was with the drug susceptibility rate of 96.0% to levofloxacin,and the drug resistance rates to other common antibiotics were all higher than 80.0%.CONCLUSION The gram-negative bacilli are the main pathogens causing lower respiratory tract infections,and they are seriously multidrug-resistant.The fungal infections keep an upward tendency,thus the hospital should intensify the microbiology examination and reasonable use of antibiotics so as to avoid the dysbacteriosis.