医院呼吸道感染病原菌种类及其耐药性分析

Analysis of pathogenic species causing nosocomial respiratory tract infections and their drug resistance

目的分析医院呼吸道感染病原菌种类及其耐药性,为医院感染控制措施的制定提供依据。方法收集2009年6月-2013年10月本院住院病例中发生医院感染患者的病例资料,对引起呼吸道感染的病原菌及其对常用抗生素的耐药性进行分析。结果发生医院感染的677例患者中,属呼吸道感染264例,占38.99%。其中上呼吸道感染86例,下呼吸道感染178例,分别占32.58%和67.42%。上呼吸道感染者标本分离出的病原菌包括:呼吸道合胞病毒33株,占38.37%;,溶血性链球菌21株,占24.4%,肺炎球菌11株,占12.79%;腺病毒7株,占8.14%;鼻病毒5株,占5.81%;埃可病毒、柯萨奇病毒各4株,各占4.65%;风疹病毒1株,占1.16%。医院下呼吸道感染病原菌主要有金黄色葡萄球菌、表皮葡萄球菌、铜绿假单胞菌、克雷伯菌、大肠埃希菌、不动杆菌、枸橼酸杆菌、白色念珠菌等,分别占6.74%、6.74%、15.16%、11.80%、5.62%、10.11%、7.30%和6.18%。其他细菌感染占10.69%,其他真菌感染占7.30%。药敏试验显示下呼吸道感染的金黄色葡萄球菌、表皮葡萄球菌等G+球菌对头孢西丁、头孢噻肟钠、头孢呋新、氨苄西林、青霉素、头孢唑啉、头孢吡肟、哌拉西林/他唑巴坦、洛美沙星耐药性均较高,耐药率均在60%以上,而对米诺环素和万古霉素较敏感。铜绿假单胞菌、麦芽寡养单胞菌、大肠埃希菌、克雷伯菌、枸橼酸杆菌、不动杆菌等G-球菌普遍对氧哌嗪、头孢唑啉、头孢吡肟、头孢呋新耐药,耐药率可高达70%以上。结论医院呼吸道感染病原菌主要有金黄色葡萄球菌、表皮葡萄球菌、铜绿假单胞菌、克雷伯菌、大肠埃希菌、不动杆菌、链球菌及病毒等,且多数致病菌对常用抗生素普遍耐药,治疗时应根据药敏试验结果选用药物,杜绝不合理使用或滥用抗生素,预防和延缓耐药菌的产生。

Objective To analyze the pathogenic species causing nosocomial respiratory tract infections and their drug resistance in order to provide a basis for measures to control nosocomial infections. Methods Data on patients with nosocomial infections at this Hospital were collected from June 2009 to October 2013. The pathogenic species causing nosocomiai respiratory tract infections and their and drug resistance were analyzed. Results Of 677 patients with a nosocomial infection, 264 had a respiratory tract infection, accounting for 38.99%. Of all patients with a respiratory tract infection, 86 had an upper respiratory tract infection, accounting for 32.58%, while 178 had a lower respiratory tract infection, accounting for 67.42 G. The pathogens isolated from patients with an upper respiratory tract infection included the respiratory syncytial virus （33 strains, accounting for 38.37 %）, hemolytic Streptococcus （21 strains, accounting for 24.4 %）, Pneumococcus （11 strains, accounting for 12. 79%）, Adenovirus （7 strains, accounting for 8. 14%）, Rhinovirus （5 strains, accounting for 5.81%）, ECHO virus （4 strains, accounting for 4.65%）, Coxsackievirus （4 strains, accounting for 4.650%）, and Rubella virus （1 strain accounting for 1.16 %）. The pathogens isolated from patients with a lower re- spiratory tract infection included Staphylococcus aureus （6.74 %）, Staphylococcus epidermidis （6.74%）, Pseudomonas aeruginosa （ 15. 16%）, Klehsiella （ 11. 80%）, Escherichia coli （ 5. 62%）, Aeinetobacter （ 10. 11%）, Citrohacter （7.30%） and Candida albicans （6.18%）. Other bacteria accounted for 10.69% of the pathogens identified while other fungi accounted for 7.30%. A drug sensitivity test indicated that Staphylococcus aureus and Epidermis staphylococcus, both of which are Gram-positive cocci that cause lower respiratory infections, had very high resistance （above 60 % ） to ce- foxitin, cefotaxime sodium, cefuroxime, ampieillin, penicillin, cefazolin, cefepime, piperacillin/tazobactam, and lome- floxacin. However, these Gram-positive cocci were sensitive to minocycline and vancomycin. The drug sensitivity test also indicated that Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Escherichia coli, Klebsiella, Citrobacter and Acinetobacter, which are Gram-negative cocci, had very high resistance （above 70%） to piperacillin, cefazolin, cefepime, and cefuroxime. Conclusion The pathogenic bacteria that caused nosocomial respiratory tract infections mainly include Staphylococcus aureus, Epidermis staphylococcus, Pseudomonas aeruginosa, Klebsiella, Escherichia coli, Acinetobacter, and other Streptococcus spp. Most of these pathogenic bacteria were generally resistant to commonly used antibiotics. When treating a nosocomial respiratory tract infection, drugs should be chosen based on the results of susceptibility testing to put an end to irrational use or misuse of antibiotics and thus prevent or delay the generation of drug-resistant bacte ria.