自贡地区痰培养中分离菌的临床分布及耐药性分析

Clinical distribution and drug resistance of isolated bacteria in sputum culture in Zigong area

目的了解自贡地区下呼吸道感染病原菌的临床分布及耐药情况,为临床合理使用抗菌药物提供参考。方法收集2017年自贡地区所有三级综合医院痰培养阳性菌株及药敏结果,采用WHONET 5.6及SPSS 19.0软件对数据进行分析。结果共分离出3 989株细菌,其中革兰阳性菌924株,占23.2%,革兰阴性菌3 065株,占76.8%,前5位的细菌分别为肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌、鲍曼不动杆菌和肺炎链球菌。前5位分离菌的耐药结果为:肺炎克雷伯菌对头孢他啶、头孢吡肟、头孢替坦、哌拉西林/他唑巴坦、妥布霉素、阿米卡星、环丙沙星及左氧氟沙星耐药率较低(<10%),产超广谱β-内酰胺酶(ESBLs)菌的检出率为19.8%,未分离出耐厄他培南或亚胺培南的菌株;铜绿假单胞菌对常见抗菌药物耐药率较低,对亚胺培南的耐药率为7.8%,未成年组中未分离出耐喹诺酮类或妥布霉素的菌株;金黄色葡萄球菌对青霉素和红霉素耐药率高(>60%),对莫西沙星和利福平耐药率低(<10%),耐甲氧西林金黄色葡萄球菌(MRSA)的检出率为20.3%,未分离出耐万古霉素、利奈唑胺或奎奴普丁/达福普汀的菌株;鲍曼不动杆菌对常见抗菌药物耐药率较高,对亚胺培南耐药率为60.4%;肺炎链球菌对红霉素和四环素耐药率高(>90%),未分离出耐青霉素、阿莫西林、万古霉素、利奈唑胺或厄他培南的菌株。结论自贡地区下呼吸道感染病原菌以革兰阴性菌为主,但不同年龄组的病原菌谱及耐药谱存在较大差异。同时,本地区下呼吸道的鲍曼不动杆菌耐药严峻,各医院感控部门及政府卫生决策部门应充分重视。

Objective To understand the clinical distribution and drug resistance of pathogens of lower respiratory tract infection in Zigong area,and provide reference for clinical rational use of antibiotics.Methods The drug susceptibility results of positive strains in sputum culture from the third-class comprehensive hospital of Zigong district in 2017 were collected,and data were analyzed by WHONET 5.6 and SPSS 19.0 software.Results A total of 3 989 strains of bacteria were isolated,of which 924 were Gram-positive bacteria(23.2%)and 3 065 Gram-negative bacteria(76.8%).The top five bacteria were Klebsiella pneumoniae,Pseudomonas aeruginosa,Staphylococcus aureus,Acinetobacter baumannii,and Streptococcus pneumoniae respectively.The results of drug resistance of the top five isolates were as follows:The resistant rates of Klebsiella pneumoniae to ceftazidime,cefepime,cefotitan,piperacillin/tazobactam,tobramycin,amikacin,ciprofloxacin and levofloxacin were lower(<10%).The detection rate of ESBL producing bacteria was 19.8%.And ertapenem-resistant or imipenem-resistant Klebsiella pneumoniae were not isolated.The resistance rate of Pseudomonas aeruginosa to common antimicrobial agents was low,and the resistance rate to imipenem was 7.8.No quinolones or tobramycin resistant strains was isolated from minors.The resistance rate of Staphylococcus aureus to penicillin and erythromycin was high(>60%),and low resistance to moxifloxacin and rifampicin(<10%),and the detection rate of methicillin-resistant Staphyloccus aureus(MRSA)was 20.3%.The strains resistant to vancomycin,linazolamine or quinaputin/dafopudine were not isolated.The resistance rate of Acinetobacter baumannii to common antimicrobial agents was higher,and which was 60.4% to imipenem.Streptococcus pneumoniae showed high resistance to erythromycin and tetracycline(>90%),and no strains resistant to penicillin,amoxicillin,vancomycin,linazolamine or etapenem were isolated.Conclusion Gram-negative bacteria are the main pathogens of lower respiratory tract infection in Zigong area,but there are significant differences in the spectrum of pathogens and drug resistance among different age groups.Clinicians should treat microbial thinking for empirical treatment of anti-infection.And at the same time,the resistance of Acinetobacter baumannii in the lower respiratory tract of this region is severe,and the hospital’s sensory control departments and government health decision-making departments should pay full attention.