某三甲医院医院获得性肺炎病原菌分布及耐药性分析

Distribution and drug resistance of hospital acquired pneumonia in a top three hospital

目的分析某三甲医院医院获得性肺炎（Hospital acquired pneumonia,HAP）病原菌分布及耐药性,指导临床合理使用抗菌药物。方法收集并分析某三甲医院2014年6-12月HAP患者标本分离培养的病原菌种类分布及其药物敏感试验结果,采用WHONET 6.0软件进行统计分析。结果 513例HAP患者送检标本共分离出病原菌621株,其中革兰阴性菌454株占73.11%、真菌101株占16.26%、革兰阳性菌66株占10.63%。分离前4位的病原菌,鲍曼不动杆菌占20.61%、肺炎克雷伯杆菌占15.94%、铜绿假单胞菌占14.17%、金黄色葡萄球菌占7.73%。鲍曼不动杆菌除对米诺环素耐药率为4.32%外,其它几种抗菌药物耐药率均〉50%;肺炎克雷伯杆菌耐药率均未〈50%;铜绿假单胞菌除哌拉西林、哌拉西林他唑巴坦和亚胺培南外,对其它抗菌药物耐药率均〉50%;金黄色葡萄球菌除氯霉素、万古霉素外,对其它抗菌药物耐药率〉50%,其中耐甲氧西林的金黄色葡萄球菌检出率为65.73%。结论医院获得性肺炎患者病原菌以革兰阴性菌为主,常见病原菌耐药性严重,应根据药物敏感试验结果选用合适的抗菌药,减少经验性用药。

Objective To analyze the distribution and drug resistance of hospital acquired pneumonia in a top three hospital,in order to guide the clinical rational use medication of antibiotics. Methods Collect and analyze the distribution and drug sensitive test results of HAP samples in a top three hospital from June 2014 to December 2014,while data analysis on WHONET 6. 0. Results 621 strains of pathogens were isolated from513 HAP samples,including： 454 trains of Gram-negative bacteria（ 73. 11%）,101 strains of fungus （ 16. 26%） and 66 strains of Gram-positive bacteria（ 10. 63%）. The major pathogenic bacteria covering acinetobacter baumannii 20. 61%,klebsiella pneumoniae 15. 94%,pseudomonas aeruginosa 14. 17% and staphylococcus aureus 7. 73%. The resistant rate of acinetobacter baumannii is generally over 50%,excluding to minocycline was 4. 32%; the rate of klebsiella pneumoniae is no more than 50%; pseudomonas aeruginosa＇s general rate is over 50%,not including its tolerance to piperacillin,piperacillin-tazobactam and imipenem; Staphylococcus aureus＇ general resistant rate towards antimicrobials（ except for chloromycetin and vancomycin） is over 50%,with a 65. 73% prevalence of MRSA. Conclusions One major pathogenic bacteria of HAP patients is gram-negative one. And there is a rather high resistant rate among those pathogenic bacterium. Therefore it＇s necessary to choose proper antibacterial according to the sensitivity test rather than according to experience.