呼吸内科成人下呼吸道感染病原菌的动态监测

Dynamic monitoring of pathogens causing lower respiratory tract infections to adults in respiratory medicine department

目的了解呼吸内科成人患者下呼吸道感染病原菌的特点和变化趋势,为临床诊治和科学选药提供依据。方法动态监测2011-2012年医院呼吸内科送检的痰标本微生物检测和药敏率,药敏试验采用CLSI推荐的K-B纸片法,结果评价按照CLSI 2010年版的标准进行判断;将数据导入Excel软件,并对数据进行统计分析。结果 2012年呼吸内科送检的痰标本检出菌株较2011年明显增多,各年份与两年总体检出病原菌的构成比基本一致,2011-2012年共培养出病原株632株,其中革兰阴性菌325株占51.42%;真菌267株占42.25%;革兰阳性菌40株占6.33%,主要革兰阴性菌对氨苄西林的耐药率均较高,对头孢类抗菌药物的耐药率程度不一,但对美罗培南、亚胺培南敏感性较高;真菌对氟胞嘧啶的耐药率均>70.0%,但假丝酵母菌属对制霉菌素和两性霉素B的耐药率为0,而曲霉菌属对伊曲康唑的耐药率为0。结论下呼吸道感染病原菌以革兰阴性杆菌为主,真菌感染病例明显增加;医疗机构应建立动态监测体系和定期发布制度,临床医务人员要及时了解医院感染病原菌变化及抗菌药物的耐药性变化,并及时送检临床标本,为合理选药提供依据。

OBJECTIVE To understand the characteristics and variation trend of pathogens causing lower respiratory tract infection to adult patients in respiratory medicine department so as to provide basis for diagnosis, treatment, as well as scientific drug selection in clinical practice. METHODS The identification and drug resistance rate of organisms in the sputum specimens submitted by respiratory medicine department from 2011 to 2012 were dynamically monitored; K-B method recommended by Clinical And Laboratory Standards Institute （CLSI） was adopted for drug sensitivity test, and the results were determined according to the standard of CLSI （2010 version）, the data were input in Excel software and was statistically analyzed. RESULTS The pathogens detected from the specimens submitted by respiratory medicine department in 2012 were obviously more than that in 2011, and the constituent ratio of pathogens of each year and that of the total two years were basically the same; a total of 632 strains of pathogens were cultured from 2011 to 2012, including 325 strains of gram-negative bacteria （51.42 %）, 267 strains of fungi （42.25%）, and 40 strains of gram-positive bacteria （6.33%） ; all the dominant gram-negative bacteria had high drug resistance rates to ampicillin, had different degrees of drug resistance rates to cephalosporin antibiotics, but had relatively high sensitivity to meropenem and imipenem; all fungi had the drug resistance rate above 70.0% to flucytosine, but the drug resistance rates of Candida mycoderma （C.-rnycoderma） to nystatin and amphotercin B were 0, and the drug resistance rate of Aspergillus to itraconazole was 0. CONCLUSION The main pathogens causing lower respiratory tract infection were gram -negative bacilli, and the cases infected by fungi were significantly increased; so the medical institutions should establish a dynamic monitoring system and regular release system, and clinical medical personnel should timely learn about the changes of pathogens causing nosoco- mial infections and the changes of resistance to antibiotics, and timely submit the clinical specimens to provide hasis for rational drug selection.