支气管扩张患者急性感染的病原菌分布与药敏分析

Distribution and drug sensitivity of pathogens of acute infections in patients with bronchiectasis

目的观察和分析支气管扩张急性感染的病原菌分布及耐药性,进一步提高对临床表现的认识与及时处理。方法选择医院2012年1月-2013年1月500例支气管扩张急性感染住院患者为研对象,采用Microscan AntoSCAN-4微生物鉴定仪器或药敏试验配套装置进行药物敏感性测定,对细菌培养后痰标本的病原菌分布以及药敏试验结果进行分析。结果 500例痰标本中分离出200株病原菌,检出率为40.0%,其中有175株为革兰阴性杆菌占87.5%,25株为革兰阳性球菌占12.5%;总数排在前6位的分别有铜绿假单胞菌37株、鲁氏不动杆菌31株、肺炎克雷伯菌18株、肠杆菌属12株、鲍氏不动杆菌10株、金黄色葡萄球菌9株;铜绿假单胞菌对阿米卡星、亚胺培南、头孢吡肟、哌拉西林以及环丙沙星表现出的耐药性较高,均>90.0%,鲍氏不动杆菌的耐药率普遍较低,金黄色葡萄球菌只对利奈唑胺、亚胺培南和万古霉素敏感率达到100.0%。结论以铜绿假单胞菌为主的革兰阴性菌是支气管扩张急性感染患者的主要病原菌,抗菌药物的合理选用可以有效减少耐药菌的产生。

OBJECTIVE To observe and analyze the distributions and drug resistance of pathogens of acute infection in patients with bronchiectasis,and further improve the understanding of clinical manifestations and timely treatment.METHODS A total of 500inpatients with bronchiectasis who had acute infections from Jan.2012to Jan. 2013were taken as the study subjects.The drug susceptibility test was performed with the Microscan AntoSCAN-4or the susceptibility test device.The distribution of pathogens after sputum sample culture and the susceptibility test result were analyzed.RESULTS A total of 200pathogens were isolated from 500sputum samples,with the detection rate of 40.0%,of which there were 175gram-negative bacilli（87.5%）,25gram-positive coccid（12.5%）.The top six in total amount were Pseudomonas aeruginosa（37strains）,Acinetobacter lwoffii（31strains）,Klebsiella pneumoniae（18strains）,Enterobacter（12strains）,Acinetobacter baumannii（10 strains）,Staphylococcus aureus（9strains）.Pseudomonas aeruginosa had high resistance of＆gt;90%to amikacin, imipenem,cefepime,piperacillin and ciprofloxacin.The resistance of A.baumannii was generally lower.S.aureus was only resistant to linezolid,imipenem and vancomycin,with the resistance rate of 100%.CONCLUSION Gram-negative bacteria,mainly P.aeruginosa,are the main pathogen of acute infection in bronchiectasis patients, rational use of antimicrobial drugs can effectively reduce the occurrence of drug-resistant bacteria.