慢性心力衰竭患者合并肺部感染的病原菌分布及耐药性分析

Distribution and drug resistance of pathogens isolated from chronic heart failure patients complicated with pulmonary infection

目的分析慢性心力衰竭患者合并肺部感染的病原菌分布及耐药性,为临床抗菌药物的合理应用提供依据。方法选择从2014年5月-2015年5月医院就诊72例慢性心力衰竭合并肺部感染患者,分析患者感染病原菌的分布情况及药敏试验结果。结果 72例患者共分离病原菌91株,其中革兰阴性菌55株,占60.4%;革兰阳性菌34株,占37.4%;真菌2株,占2.2%;革兰阴性菌对氨基糖苷类、喹诺酮类、第三代头孢菌素等抗菌药物耐药性较高,其中肺炎克雷伯菌,鲍曼不动杆菌及铜绿假单胞菌对链霉素的耐药率可达100.0%,鲍曼不动杆菌及铜绿假单胞菌对环丙沙星等耐药率也为100.0%,大肠埃希菌,鲍曼不动杆菌及铜绿假单胞菌对头孢曲松达100.0%耐药;而对美洛培南、亚胺培南、阿米卡星及头孢哌酮/舒巴坦等仍然较敏感,大肠埃希菌对美洛培南、亚胺培南的耐药率为3.6%,对阿米卡星及头孢哌酮/舒巴坦的耐药率为7.1%,肺炎克雷伯菌对美洛培南、亚胺培南的耐药率为13.3%,对阿米卡星及头孢哌酮/舒巴坦的耐药率为26.7%和20.0%,革兰阳性菌对青霉素、克林霉素等普遍耐药,肠球菌和金黄色葡萄球菌对青霉素G的耐药率均为80.0%,对克林霉素的耐药率为100.0%,但对万古霉素,替考拉宁,利福平等仍然较敏感,肠球菌对万古霉素,替考拉宁,利福平的耐药率分别为0.5%,1.0%和30.0%,金黄色葡萄球菌对万古霉素,替考拉宁,利福平的耐药率分别为11.1%,11.1%和1.1%。结论慢性心力衰竭合并肺部感染的患者在分离菌株中仍然以革兰阴性致病菌为主,美洛培南、亚胺培南、阿米卡星及头孢哌酮/舒巴坦等抗菌药物仍然是较敏感药物,为临床用药提供依据。

OBJECTIVE To investigate the distribution and drug resistance of pathogens isolated from chronic heart failure patients complicated with pulmonary infection so as to provide guidance for reasonable clinical use of antibiotics.METHODS A total of 72 chronic heart failure patients complicated with pulmonary infection who were treated in the hospital from May 2014 to May 2015 were enrolled in the study.The distribution of the pathogens causing the infection was analyzed,and the result of drug susceptibility testing was observed.RESULTS Totally 91 strains of pathogens were isolated from the 72 patients,including 55（60.4%）strains of gram-negative bacteria,34（37.4%）strains of gram-positive bacteria,and 2（2.2%）strains of fungi.The gram-negative bacteria were highly resistant to aminoglycosides,quinolones,and third generation cephalosporins;the drug resistance rates of Klebsiella pneumoniae,Acinetobacter baumannii,and Pseudomonas aeruginosa to streptomycin were as high as100.0%.The drug resistance rates of A.baumannii and P.aeruginosato ciprofloxacin were 100.0%.The drug resistance rates of Escherichia coli,A.baumannii,and P.aeruginosa to ceftriaxone were as high as 100.0%;however,the strains remained highly susceptible to meropenem,imipenem,amikacin,and cefoperazone-sulbactam.The drug resistance rate of the E.coli to meropenem and imipenem was 3.6%;the drug resistance rate to amikacin and cefoperazone-sulbactam was 7.1%.The drug resistance rate of the K.pneumoniaeto meropenem and imipenem was 13.3%;the drug resistance rates to amikacin and cefoperazone-sulbactam were 26.7%and 20.0%,respectively.The gram-positive bacteria were generally resistant to penicillin and clindamycin;the drug resistance rates of Enterococcus and Staphylococcus aureus to penicillin G were 80.0%,the drug resistance rates to clindamycin were 100.0%,however,the strains remained highly susceptible to vancomycin,teicoplanin,and rifampicin.The drug resistance rates of the Enterococcus to vancomycin,teicoplanin,and rifampicin were 0.5%,1.0%,and 30.0%,respectively;the drug resistance rates of the S.aureus to vancomycin,teicoplanin,and rifampicin were 11.1%,11.1%,and 1.1%,respectively.CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the chronic heart failure patients complicated with pulmonary infection.Meropenem,imipenem,amikacin,and cefoperazone-sulbactam remain susceptible to the strains,which provides guidance for clinical use of antibiotics.