呼吸内科下呼吸道感染病原菌及耐药分析

THE PATHOGEN AND DRUG RESISTANCE ANALYSIS OF LOWER RESPIRATORY TRACT INFECTION IN DEPARTMENGT OF RESPIRATORY MEDICINE

目的为了指导临床合理用药,探讨呼吸内科下呼吸道感染患者病原菌分布以及耐药性情况。方法选取2010年4月—2013年7月,呼吸内科下呼吸道感染患者480例,采集所有患者痰及支气管灌洗液标本进行病原菌检测,菌种鉴定采用法国生物梅里埃公司的VITEK-60全自动细菌分析仪,药物敏感试验采用K-B纸片扩散法。结果革兰阴性菌463株(58.61%),其中大肠埃希菌(233株,29.49%)、肺炎克雷伯菌(148株,18.73%)占主要;革兰阳性菌259株(32.78%),其中粪肠球菌最多,有165株(20.89%);真菌有68株,8.61%。革兰阴性(G-)杆菌对于喹诺酮类、氨基糖苷类、第三代头孢菌素等抗菌物耐药率较高,其中耐药率较低的是亚胺培南、头孢哌酮/舒巴坦、哌拉西林/唑巴坦;革兰阳性(G+)球菌对克林霉素、左旋氧氟沙星、红霉素、青霉素有较高的耐药性;真菌的耐药率普遍较低。结论呼吸内科下呼吸道感染患者尿路感染病原菌主要以革兰菌为主,病原菌分布以及耐药性分析要保持监测,根据监测结果要合理临床使用抗菌药,以此减少新耐药株的形成,同时降低医院感染的发生。

Objective To explore the pathogen distribution and drug resistance of lower respiratory tract infection in department of Respiratory Medicine to guide rational drug. Methods All patients, 480 cases of lower respiratory tract infection in the department of Respiratory Medicine from April 2010 to July 2013 were collected sputum and bronchial ravage specimens for pathogen detection, strain identification used French bioMérieux VITEK - 60 automatic bacteria analyzer, drug susceptibility tes-ting used KB disk diffusion method. Results Gram-negative bacteria 463 （58. 61%）, of which Escherichia coli （233, 29. 49%）, Klebsiella pneumonia （148, 18. 73%） accounted for the major; Gram-positive bacteria 259 （32.78%）, of which a maximum of Enterococcus facials, there were 165 （20.89 % ） ; fungi 68 （8.61%）. Gram - negative （G^-） bacilli for quinolones, amino glycosides, third - generation cephalosporin antibiotic resistance rates higher material which was resistant to.low rates of impanel, cefoperazone / Sheba Tanzania, piperacillin / tazobactam; Gram- positive （G^＋ ） bacteria to clindamycin, levofloxacin, erythromycin, penicillin had a higher resistance; fungal resistance rate was generally low. Conclusions The pathogen in patients with lower respiratory tract infection in de-partment of Respiratory Medicine mainly is Gram- bacteria - based. In order to reduce the formation of new resistant strains and hospital infection, the distribution and drug resistance of pathogen should be kept monitoring to reasonable clinical use of antimicrobial drugs.