呼吸内科住院患者下呼吸道感染的病原菌谱及耐药性观察

Bacterial spectrum and drug resistance of lower respiratory tract infection in hospitalized patients in Respiratory ward

目的探究呼吸内科住院患者下呼吸道感染的病原菌谱及耐药性。方法随机抽取我院2015年1月~2016年1月收治的呼吸内科住院患者956例痰液标本进行检验,分析标本中病原菌的构成情况及其耐药性。结果 956例痰液标本中共分离出481例病原菌,检出率为50.3%。其中革兰阴性菌301株,占62.6%(301/481);革兰阳性菌120株,占24.9%(120/481);真菌60株,占12.5%(60/481)。在革兰阴性菌中,铜绿假单胞菌占比最高,占21.2%(102/481);革兰阳性菌中,肺炎链球菌的占比最高,占12.5%(60/481);真菌中白假丝酵母菌的占比最高,占6.6%(32/481)。革兰阴性菌中铜绿假单胞菌耐药性最严重的是氨苯西林(92.12%)、头孢曲松(79.63%)及头孢唑林(79.85%);肺炎克雷伯菌耐药最严重的是头孢曲松(88.25%)、头孢唑林(87.36%)、氨苯西林(85.69%)及头孢噻肟(79.25%);鲍曼不动杆菌耐药最严重的是头孢曲松(89.69%)、头孢噻肟(85.69%)及头孢唑林(84.62%)。革兰阳性菌中耐甲氧西林葡萄球菌耐药性最严重的是红霉素(100%)、阿莫西林克拉维酸(100%)及四环素(79.63%);金黄色葡萄球菌耐药性最严重的是红霉素(100%)、阿莫西林克拉维酸(100%)及四环素(91.63%);肺炎链球菌耐药性最严重的是红霉素(100%)、阿莫西林克拉维酸(98.63%)及四环素(93.63%).结论下呼吸道感染的患者,革兰阴性菌的占比最大,铜绿假单胞菌是主要的病原菌,致病菌对各种药物的耐药性各不相同,应该根据具体的药敏试验结果合理的使用抗菌药物。

Objective To explore the pathogenic bac- teria and drug resistance of respiratory hospitalized patients with lower respiratory tract infection.Methods 956 speci- mens of hospitalized patients in our hospital from January 2015 to January 2016 were randomly selected and tested.analysis of The composition and drug resistance of pathogenic bacteria was analyzed. Results Pathogenic bacteria was isolated in of 481 specimens. The detection rate was 50.3%. Among all these pathogens, there were 301 strains of gram negative bac- teria which isaccounted for 62.6% （301/481） , 120 strains of gram positive bacteria, accounting for 24.9% （ 10/481 ） , 60 strains of fungi, accounting for 12.5% （60/481） . Among Gram-negative bacteria, Pseudomonas aeruginosa accounted for the highest, of which 102 strains accounted for 21.2% （102/481 ） . Among gram positive bacteria, there were 60 strains of Streptococcuspneumoniae （60/481, 12.5%） which is the highest proportion; Candida albicans accounted for the largest propotion in fungi （32/48l, 6.6%） . In Gram negative bacteria, the degree of resistence of Pseudomonas aeruginosa is dapsone （92.12%） , ceftriaxone （79.85%） , cefazolin （79.63%） ; the drug resistance of Klebsiella pneumoniae isolated is ceftriaxone （88.25%） , cefazolin （87.36%） , dapsone resistant （85.69%） and cefotaxime （79.25%） ; Bauman is resistant to eeftriaxone （89.69%） , cefotaxime （85.69%） , cefazolin （84.62%） . In Gram positive bacte- ria, methicillin resistant Staphylococcus is resistantto erythro- mycin （100%） , amoxicillin clavulanic acid （100%） and tetracycline （79.63%） ; the most serious drug resistance of Staphylococcus aureus were erythromycin （100%） , amox- icillin clavulanate （100%） and tetracycline （91.63%） ; the most serious drug resistance of Streptococcus pneumoni- ae is erythromycin （100%） , amoxicillin clavulanic acid （98.63%） and tetracycline （93.63%） . Conclusion In patients with lower respiratory tract infection, gram negative bac- teria accounted for the largest propotion of pathogen, Pseudomo- nas aeruginosa is the main pathogen. The resistance of pathogenic bacteria is not the same.So we should choose antibiotics according to the specific drug sensitivity test.