呼吸科肺部感染病原菌类型及危险因素分析

Pathogen type and risk factors of patients with lung infection in respiratory department

目的：分析我院呼吸科肺部感染的病原菌分布及耐药特点。方法收集我院2009年1月~2011年12月下呼吸道标本检出的3062株分离菌进行药敏和耐药性分析并与医院感染监控系统进行比较。结果3062株分离菌中革兰氏阴性（G-）杆菌1515株（49．47%）；革兰氏阳性球菌337株（11．02%）。 G-杆菌中铜绿假单胞菌居于首位，占49．06%，其次是：鲍曼不动杆菌18．25%，大肠埃希菌12．57%，肺炎克雷伯菌8．42%。 G＋球菌主要为金黄色葡萄球菌占89．32%。多重耐药菌1088株，其中产超广谱β-内酰胺酶（ ES-BLs）大肠埃希菌156株（14．34%），肺炎克雷伯菌69株（6．34%），金黄色葡萄球菌中 MRSA 269株，占24．81%，多重耐药铜绿假单胞菌和鲍曼不动杆菌分别为116株（10．66%）和209株（19．21%）。结论肺部多重耐药菌感染增加，应加强药物敏感试验监控，合理用药，制定有效消毒隔离措施，预防和控制多重耐药菌的传播。

Objective To analyze the distribution and drug-resistant features of pathogens of patients with lung infection in respiratory department in our hospital. Methods 3062 strains of bacteria from lower respiratory tract were collected to detect drug susceptibility. The results were compared to the data from the system of hospital in-fection monitoring. Results 1515 strains were gram-negative bacilli （49. 47%）, and 337 strains were gram-positive cocci （11. 02%. The top four gram-negative bacilli were P. aeruginosa （49. 06%）, acinetobacter spp （18. 25%）, E. coli （12. 57%）, and K. pneumoniae （8. 42%）. Gram positive cocci mainly included S aureus （89. 32%）. A-mong 1088 multi-drug-resistant （ MDR） bacteria, ESBLs of E. coli accounted for 14. 34% and K. pneumoniae took up 6. 34%. MRSA accounted for 24. 81%, MDR of P. aeruginosa accounted for 10. 66% and acinetobacter spp for 19. 21%. Conclusion Multi-drug resistant bacteria of lung infection are increasing. Measures should be taken to strengthen the monitoring of drug susceptibility test, rational use of antibiotics and institution of effective disinfection methods, for the purpose of prevention of spreading of MDR bacteria inside respiratory ward.