辽宁省近5年痰培养主要病原菌分布及临床意义

Distribution of Main Pathogens in Sputum Culture in Liaoning Province in Recent Five Years and Clinical Significance

了解住院患者痰培养的病原菌分布及其对常用抗菌药物的耐药情况,为临床合理用药提供参考。回顾性分析辽宁省2015年1月至2019年12月共3878份痰标本感染菌鉴定结果和铜绿假单胞菌(Pseudomonas aeruginosa)的药敏试验结果。采用法国梅里埃VITEK 2 Compact全自动微生物鉴定仪进行菌种鉴定,并对从门诊和住院下呼吸道感染患者中分离的785株铜绿假单胞菌进行药物敏感试验分析。结果表明,痰培养病原菌以革兰阴性杆菌为主,占68.9%,其次为真菌。在革兰阴性杆菌中,铜绿假单胞菌占20.2%。铜绿假单胞菌对氨苄西林、呋喃妥英、复方新诺明、头孢呋辛(酯)、头孢曲松、头孢替坦、头孢唑啉的耐药性较高,每年的耐药率均高于95%。而对于阿米卡星、环丙沙星、头孢吡肟、头孢他啶、左氧氟沙星则出现较低的耐药性,5年的耐药率均低于50%。铜绿假单胞菌对阿米卡星、哌拉西林、头孢吡肟、美罗培南、亚胺培南的耐药率有逐年下降的趋势,而对环丙沙星、左氧氟沙星的耐药率有逐年上升的趋势。以上结果表明辽宁省近5年痰培养主要致病菌为革兰阴性杆菌,其中铜绿假单胞菌占很大的比例。铜绿假单胞菌易产生多重耐药性,必须加强耐药性监测,为临床提供最新的耐药性资料,以便更好地控制铜绿假单胞菌的感染,同时也对临床合理使用抗生素有指导意义。

In order to investigate and analyze the distribution of main pathogenic bacteria in sputum cultures and their drug resistance to common used antibiotic agents,Pseudomonas aeruginosa from 2 nd affiliated hospital of Liaoning University of TCM,provide references with reasonable usage of antibiotic.3878 cases of sputum bacterial cultures and sensitivity test results of P.aeruginosa in Liaoning Province from January 2015 to December 2019 were retrospectively analyzed.French Biological Merryella API full automatic detection system was used to identify the bacteria.K-B disc diffusion method was performed to detect the drug susceptibility of 785 strains of P.aeruginosa isolated from in-and out patients with respiratory tract infection.Sputum cultures pathogen with Gram-negative bacilli was given priority to,accounting for about 68.9%,followed by fungi.Drug resistance rates of P.aeruginosa to ampicillin,nitrofurantoin,sulfamethoxazole,cefuroxime(axetil),ceftriaxone,cefotetan,cefazolin were all high,and to amikacin,ciprofloxacin,cefepime,ceftazidime,levofloxacin were all low,the drug resistant rate in five years was below 50%.The resistance rates of P.aeruginosa to amikacin,piperacillin,cefepime,meropenem and imipenem decreasing trend year by year,but it was opposite in ciprofloxacin and levofloxacin.The above results showed that Gram-negative bacilli was the main pathogenic bacteria in recent five years′sputum cultures in Liaoning Province,among them P.aeruginosa account for a large proportion of its resistance.Since P.aeruginosa is easy to produce multi-resistance,drug resistance monitor must be strengthened to provide the latest resistance information of P.aeruginosa clinically so that P.aeruginosa infection could be controlled better and direct rational usage of antibiotics.