心功能不全合并下呼吸道感染患者病原菌分布与耐药性分析

The distribution and resistance of pathogens in patients with cardiac insufficiency complicated with lower respiratory tract infections

目的分析心功能不全合并下呼吸道感染患者的病原菌分布规律及其耐药性特点,以指导临床合理用药。方法采用API系统进行菌种鉴定,采用K-B法进行药敏试验,采用纸片扩散表型确证法进行超广谱β-内酰胺酶(ESBLs)测定。结果 244株病原菌以G-杆菌最多(66.39%),主要是肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌;真菌其次(28.28%),主要是白色假丝酵母菌;G+球菌较少(5.33%),主要是金黄色葡萄球菌。G-杆菌对碳青霉稀类(美罗培南)及氟喹诺酮类(环丙沙星/左氧氟沙星)抗生素较敏感,而对头孢类耐药率较高;白色假丝酵母菌对两性霉素B的耐药率最低。结论心功能不全合并下呼吸道感染患者的主要病原菌以G-杆菌、真菌为主,白色假丝酵母菌是最常见病原菌;病原菌耐药性较强,耐药监测至关重要。

Objective To investigate the distribution and drug resistance of pathogenic bacteria from patients with cardiac insufficiency complicated with lower respiratory tract infections, so as to provide basis for reasonable application of antibiotics. Methods Clinical isolates were identified by API system and their drug resistance was tested by K-B method. The ESBLs-producing strains were detected phenotypic confirmatory disc diffusion test. Results A total of 244 strains, including Gram-negative bacteria （66. 39% ）, fungi （28. 28% ） and Gram-positive bacteria （5.33%）, were collected. The top four pathogens were Candida albicans, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii. Gram-negative bacteria were relatively sensitive to Carbapenems and Fluoroquinolones, but relatively resistant to Cephalosporins. Candida albicans were more sensitive to Amphotericin B. Conclusion Gram-negative bacilli and fungi are the major pathogens in cardiac insufficiency complicated with lower respiratory tract infections, and Candida albicans are the most common pathogens. Drug resistance surveillance is very important. Most of them show high drug resistance to antibiotics.