下呼吸道感染患者苛养菌分布及药敏情况的研究

Study on fastidious bacteria distribution and drug sensitivity situation in patients with lower respiratory tract infection

目的对下呼吸道感染患者苛养菌的分布及药敏情况进行分析,为指导临床诊治提供参考。方法选取2013年1月至2014年12月该院收治的下呼吸道感染患者痰液标本细菌培养560例,并进行综合统计分析。结果 560例患者痰液标本中共分离出苛养菌583株,其中58.75%来自普通病房,其余来自于门诊标本。苛养菌主要为卡他莫拉菌、流感嗜血杆菌、副流感嗜血杆菌和肺炎链球菌;78.04%(455/583)的苛养菌由50岁以上的患者痰液标本分离出,少见于20岁以下年龄段患者(仅5.66%);卡他莫拉菌、流感嗜血杆菌、副流感嗜血杆菌中产超广谱β-内酰胺酶分别为54.90%(84/153)、25.19%(34/135)和5.42%(11/203),未见肺炎链球菌。药敏试验结果可见第三代头孢类抗菌药物,对四种苛养菌的敏感性均超过80%,四环素敏感率均偏低,复方磺胺甲噁唑对卡他莫拉菌、流感嗜血杆菌和副流感嗜血杆菌的敏感性偏低。结论由苛养菌引起的下呼吸道感染患者在临床诊治时可以选用第三代头孢类抗菌药物,但应该参考患者的药敏试验结果,避免经验性用药,防止耐药菌种的产生。

Objective To analyze the fastidious bacteria distribution and drug sensitivity situation in the pa‐tients with lower respiratory tract infection to provide reference for clinical diagnosis and treatment .Methods 560 cases of lower respiratory tract infection in our hospital from January 2013 to December 2014 were selected and per‐formed the sputum bacterial culture ,The results were statistically analyzed .Results 583 strains of fastidious bacteria were isolated from the sputum specimens in 560 cases of lower respiratory tract infection ,in which 58 .75% of spu‐tum specimens were came from the common wards and the others were came from the outpatient specimens ,the main fastidious bacteria were moraxella catarrhalis ,haemophilus influenzae ,haemophilus parainfluenzae and streptococcus pneumoniae;78 .04% （455/583） of fastidious bacteria were came from the sputum specimens in the patients aged over 50 years old ,and rare in the patients aged below 20 years old （only 5 .66% ） .The rates of producing extended spec‐trum beta lactamases in moraxella catarrhalis ,haemophilus influenzae and haemophilus parainfluenzae were 54 .90%（84/153） ,25 .19% （34/135） and 5 .42% （11/203） respectively ,no streptococcus pneumoniae was found .The results of drug sensitive test showed that the sensitivity of third generation cephalosporins to four kinds of fastidious bacteria exceeded 80% ,the sensitive rate of tetracycline was lower ,the sensitive rate of compound sulfamethoxazole to morax‐ella catarrhalis ,haemophilus influenzae and haemophilus parainfluenzae was lower .Conclusion The patients with lower respiratory tract infection caused by fastidious bacteria can choose the third generation cephalosporins for con‐ducting treatment ,but should according to the results of the drug sensitivity test ,avoid empirical medication and pre‐vent the emergence of drug resistant strains .