医院获得性下呼吸道感染病原菌分布及耐药性分析

Distribution of pathogens and resistance analysis of hospital-acquired lower respiratory tract infection

目的了解医院获得性下呼吸道感染病原菌的构成及耐药性,为临床合理使用抗菌药物提供依据。方法对2014年1~12月943例发生医院获得性下呼吸道感染患者的痰培养和药敏结果进行回顾性统计分析。结果共分离出病原菌1 056株,来源于重症监护病房（ICU）598株（56.6%）,其中革兰阴性菌863株（81.7%）,革兰阳性菌70株（6.6%）,真菌123株（11.6%）,最常见的革兰阴性菌依次为肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌和大肠埃希菌,分别占22.5%（238/1 056）、21.4%（226/1 056）、19.2%（203/1 056）和7.7%（81/1 056）;最常见的革兰阳性菌为金黄色葡萄球菌占5.3%（56/1 056）;最常见的真菌为白色假丝酵母菌占6.7%（71/1 056）。鲍曼不动杆菌和铜绿假单胞菌对多种抗菌药物耐药,其中对碳青霉烯类抗菌药物的耐药率分别大于75%和50%;耐甲氧西林金黄色葡萄球菌（MRSA）检出率为78.6%（44/56）,未发现耐万古霉素金黄色葡萄球菌和肠球菌。结论病原菌以革兰阴性菌为主,对常用抗菌药物表现为高度耐药和多重耐药,耐甲氧西林金黄色葡萄球菌（MRSA）、耐碳青霉烯鲍曼不动杆菌（CR-AB）和铜绿假单胞菌（CR-PA）检出率高,加强病原学和耐药性监测,对于指导临床合理应用抗菌药物具有重要意义。

Objective To explore the distribution and resistance analysis of pathogens causing hospital-acquired lower respiratory tract infection in order to provide reference for the clinical reasonable application of antibiotics.Methods The results of sputum cultivation and drug susceptibility of 943 patients with hospital-acquired lower respiratory tract infection in our hospital from Jan 2014 to Dec 2014 were analyzed retrospectively.Results Totally1 056 strains of pathogens have been isolated,598strains（56.6%）were isolated in ICU,including 863（81.7%）strains of gram-negative bacteria,70（6.6%）strains of gram-positive bacteria and 123（11.6%）strains of fungus.Klebsiella peneumoniae,Acinetobacter baumannii,Pseudomonas aeruginosa and Escherichiacoli,were the most common gram-negative bacteria,accounting for 22.5%（238/1056）,21.4%（226/1056）,19.2%（203/1056）,7.7%（81/1056）,respectively.Staphylococcus aureus was the most common gram-positive bacteria,accounting for 5.3%.Candida albicans was the most common fungus,accounting for 6.7%（71/1056）.Acinetobacter baumannii and Pseudomonas aeruginosa were resistant to multiple antibiotics,the drug resistance rate to carbapenems were more than75% and 50%,respectively.The detection rates of the metihcillin-resistant S.aureus were 78.6%（44/56）,Vancomycin-resistant S.aureus and Enterococcus were not detected.Conclusion Gram-negative bacteria was the predominant pathogens.The results of drug sensitive test showed the Gram-negative bacteria were highly and multiple resistant to common antibacterial.The incidence of MRSA,CR-AB and CR-PA was high.Strengthened monitoring of etiology and drug resistance is of great significance in guiding reasonable application of antibiotics.