下呼吸道感染病人病原学检查及耐药情况分析

<title>Pathogen examination and drug-resistance analysis in the patients of lower respiratory tract infection

目的:了解下呼吸道感染病人的致病原变化及耐药情况,为临床治疗提供参考。方法:选择因下呼吸道感染的重症患者,入院时使用抗菌药物前,对痰液和血液标本进行细菌培养、分离、鉴定与药敏MIC试验。结果:下呼吸道感染的病原菌中,克雷伯菌属、铜绿假单胞菌和不动杆菌感染呈上升趋势;表皮葡萄球菌已成为重要的致病菌;葡萄球菌属耐青霉素已极为常见,部分金黄色葡萄球菌为MRSA菌株,大多数表皮葡萄球菌为MRSE菌株;几乎所有革兰氏阴性菌对氨苄青霉素不同程度耐药,部分对氨苄青霉素/β-内酰胺酶抑制剂和第三代头孢菌素耐药,少部分甚至对碳青霉烯类耐药;近3年超广谱β-内酰胺酶阳性菌株有逐年增多趋势。结论:近年来普遍性地、无节制地滥用抗生素是导致菌群失调、条件致病菌滋生和细菌耐药性产生的主要因素。应该提倡科学地、合理地应用抗生素。

<Abstrcat>Objective:To investigate the pathogenic bacteria and their drug-resistance in the patients of lower respiratory tract infection.Methods:The specimen of sputum and blood were collected in the patients of serious lower respiratory tract infection before they were treated by antibiotics. The bacteria in the specimen were isolated and cultured so as to be identified and have a drug-sensitive test.Results:The infection of Klebsiella, Ps.aeruginosa and Acinetobater were in the upward tendency, and Staphylococcus epidermidis had become the important pathogenic bacteria in lower respiratory tract infection. The drug-resistance was common in Staphylococcus in which some of Staphylococcus aureus were MRSA, and most of Staphylococcus epidemidis were MRSE. Almost all of the gram-negative bacteria were resistant to ampicillin at different degree, some were resistant to ampicillin /β-lactamase inhibator and the third generation of cephalosporin, and a small part of them were even resistant to carbopenems. The β-lactamase-positive bacteria of superbroad-spectrum were increasing steadily in recent 3 years.Conclusion:The dysbiosis, propagation of opportunistic pathogen and formation of drug-resistance are caused by the mindless use of antibiotics.Scientific and rational application of antibiotics should be advocated.