心内科患者下呼吸道感染病原菌与耐药性研究

Distribution and drug resistance of pathogens causing lower respiratory tract infections in patients of cardiology department

目的研究心内科患者下呼吸道感染病原菌分布及耐药性,指导临床用药。方法选择2013年6月-2015年6月在心内科住院并发生下呼吸道感染的患者220例,对感染病原菌进行分离鉴定,并对心内科患者下呼吸道感染病原菌及其耐药性进行分析;采用MicroScan WalkAway微生物鉴定药敏测试系统进行细菌鉴定和药敏试验。结果 220例下呼吸道感染患者共分离得到220株病原菌,其中革兰阳性菌53株占24.09%,革兰阴性菌148株占67.27%,真菌19株占8.64%,其中铜绿假单胞菌、肺炎克雷伯菌和金黄色葡萄球菌的检出率较高;金黄色葡萄球菌和表皮葡萄球菌对青霉素和红霉素的耐药性较高,均>70.0%,对替考拉宁、利奈唑胺、呋喃妥因和万古霉素的耐药性为0;铜绿假单胞菌、肺炎克雷伯菌和大肠埃希菌对氨苄西林、环丙沙星和左氧氟沙星的耐药性较高,>80.0%,对头孢哌酮/舒巴坦、亚胺培南和美罗培南的耐药性较低,<10.0%;真菌对氟康唑、制霉菌素、两性霉素B和氟胞嘧啶的耐药性较低。结论心内科患者下呼吸道感染的病原菌以革兰阴性菌为主,应加强无菌操作,合理使用抗菌药物。

OBJECTIVE To explore the distribution and drug resistance of pathogens causing lower respiratory tract infections in patients of cardiology department so as to provide guidance for clinical use of antibiotics.METHODS From Jun 2013 to Jun 2015,a total of 220 patients who were hospitalized the department of cardiology and had lower respiratory tract infections were enrolled in the study,then the pathogens causing the infections were identified,the distribution and drug resistance of the pathogens causing the lower respiratory tract infections were observed,and the bacterial identification and drug susceptibility testing were performed by using MicroScan WalkAway microorganism identification and drug susceptibility testing system.RESULTS Totally 220 strains of pathogens were isolated from the 220 patients with lower respiratory tract infections,including 53（24.09%）strains of gram-positive bacteria,148（67.27%）strains of gram-negative bacteria,and 19（8.64%）strains of fungi;the isolation rates of the Pseudomonas aeruginosa,Klebsiella pneumoniae,and Staphylococcus aureus were relatively high.The drug resistance rates of the S.aureus and Staphylococcus epidermidis to penicillin and erythromycin were more than 70.0%;the drug resistance rates to teicoplanin,linezolid,nitrofurantoin,and vancomycin were0.The drug resistance rates of the P.aeruginosa,K.pneumoniae,and Escherichia coli to ampicillin,ciprofloxacin,and levofloxacin were more than 80.0%;the drug resistance rates to cefoperazone-sulbactam,imipenem,and meropenem were less than 10.0%.The drug resistance rates of the fungi to fluconazole,nystatin,amphotericin,and flucytosine were relatively low.CONCLUSIONThe gram-negative bacteria are dominant among the pathogens causing the lower respiratory tract infections in the patients of the department of cardiology.It is necessary to strengthen the aseptic operation and reasonably use antibiotics.