呼吸道感染患者痰培养及药敏结果分析

Sputum culture of patients with respiratory tract infections and analysis of drug susceptibility

目的分析医院呼吸道感染患者痰培养致病菌的种类及其耐药性,以指导临床合理使用抗菌药物。方法对医院2012年6月-2012年11月3 689例呼吸道感染患者痰液标本进行致病菌培养及分离鉴定,并对分离出的病原菌及其耐药性进行分析。结果 3 689例患者痰培养检出阳性1 466例,阳性率为39.74%,检出革兰阴性菌1 094株占74.62%;革兰阳性菌91例占6.21%;真菌281株占19.17%;革兰阴性菌对亚胺培南、美罗培南、阿米卡星、哌拉西林/他唑巴坦、环丙沙星、左氧氟沙星等较为敏感,耐药率0.89%～53.53%;但鲍氏/醋酸钙不动杆菌除对氯霉素敏感外,对其他的抗菌药物均耐药严重,耐药率49.41%～100.00%;革兰阳性菌对万古霉素、替拉考宁等100.0%敏感,但葡萄球菌属对多种抗菌药物耐药严重,真菌对两性霉素B和氟胞嘧啶敏感性最高。结论痰培养致病菌以革兰阴性菌为主,真菌占一定比例,多药耐药严重,临床医师应重视对病原菌的检测,从而合理使用抗菌药,提高临床疗效。

OBJECTIVE To analyze the distribution and drug resistance of pathogens cultured from sputum of the patients with respiratory tract infections so as to provide guidance for reasonable clinical use of antibiotics. METHODS From Jun 2012to Nov 2012,the sputum specimens were collected from 3689patients with respiratory tract infections,then the culture,isolation,and identification of pathogens were performed,and the distribution and drug resistance of the isolated pathogens were analyzed.RESULTS The sputum specimens were cultured positive in 1466of the 3689patients with the positive rate of 39.74%,including 1094（74.62%）strains of gram-negative bacteria,91（6.21%）strains of gram-positive bacteria,and 281（19.17%）strains of fungi.The gram-negative bacteria were highly susceptible to imipenem,meropenem,amikacin,piperacillin-tazobactam,ciprofloxacin, and levofloxacin,with the drug resistance rates varying from 0.89%to 53.53%;the Acinetobacter baumannii and Acinetobacter calcium acetate were highly resistant to all the antibiotics except for chloramphenicol,with the drug resistance rates varying from 49.41%to 100.00%.The drug susceptibility rates of the gram-positive bacteria to vancomycin and teicoplanin were 100.0%,however,the Staphylococcus spp was highly resistant to many of the antibiotics.The drug susceptibility rates of the fungi to amphotericin B and flucytosine were the highest. CONCLUSION The gram-negative bacteria are dominant among the sputum-cultured pathogens,the fungi occupy a certain proportion and are highly multidrug-resistant.It is necessary for the clinicians to pay high attention to the detection of pathogens so as to reasonably use antibiotics and improve the clinical efficacy.