呼吸系统感染疾病患者主要病原菌分布及耐药性分析

Analysis on distribution and drug resistance of common pathogens of patients with respiratory infection

目的分析呼吸系统感染患者的主要病原菌分布及耐药性,为合理使用抗菌类药物提供理论依据。方法采集2019年1月—2019年12月本院呼吸科收治的支气管扩张合并感染患者的痰液等作为标本,对标本进行病原菌鉴定与药敏试验并分析结果,以了解呼吸系统感染患者常见病原菌的分布及对抗菌药物的耐药情况。结果2019年1月—2019年12月本院呼吸科普通病区共收治支气管扩张合并感染患者2534名,送检标本数1360份,送检率为53.71%,共培养出病原菌418株,分离率为30.74%。其中革兰阴性菌206例,占49.28%,以铜绿假单胞菌、肺炎克雷伯菌和鲍曼不动杆菌为主;革兰阳性菌135例,占32.30%,以肺炎链球菌、金黄色葡萄球菌、肠球菌为主;真菌77例,占18.42%,主要为白色念珠菌。革兰阴性菌中的铜绿假单胞菌对氨苄西林、复方新诺明、头孢噻肟的耐药性较高,对阿米卡星较为敏感;肺炎克雷伯菌对碳青霉烯类抗生素亚胺培南、美洛培南十分敏感;鲍曼不动杆菌对常规的抗菌药物均有较高的耐药性,仅对米诺环素较为敏感。主要革兰阳性菌均对和青霉素G和红霉素的耐药性较高,而对万古霉素较为敏感。真菌中的白色念珠菌对氟康唑、两性霉素B和氟胞嘧啶较为敏感。结论呼吸系统感染患者的主要病原菌以革兰阴性菌为主,其余为革兰阳性球菌和真菌,病原菌对常规抗菌药物的耐药性普遍较高,在临床诊疗过程中应充分利用微生物实验室对病原菌作药敏试验,针对药敏结果合理用药。

Objective To analyze distribution and drug resistance of main pathogens in patients with respiratory infection and to provide theoretical reference for rational use of antibacterial drugs.Methods The Sputum of patients with Bronchiectasis companied with infection,who were treated in our hospital from January 2019 to December 2019,were collected as samples.The pathogen were isolated from patients’sputum,and the susceptibility test was conducted by drug sensitivity test.The results were analyzed to understand the distribution of main pathogens and drug resistance.Results From January 2019 to December 2019,2534 patients with Bronchiectasis companied with infection were treated in our hospital,1360 samples were tested.The inspection rate was 53.71%,418 strains of pathogenic bacteria were isolated;the isolation rate was 30.74%.Among them,206 cases were Gram-negative bacteria accounting for 49.28%,mainly including Pseudomonas aeruginosa,Klebsiella pneumoniae and Acinetobacter baumannii.135 cases Gram-positive bacteria accounted for 32.30%,mainly including Streptococcus pneumoniae,Staphylococcus aureus and Enterococcus.There were 77 cases of Fungi accounting for 18.42%,mainly including Candida albicans.Among the Gram-negative bacteria,Pseudomonas aeruginosa was highly resistant to ampicillin,cotrimoxazole and cefotaxime,but was sensitive to amikacin.Klebsiella pneumoniae was very sensitive to carbapenem antibiotics imipenem and meropenem.Acinetobacter baumannii was highly resistant to conventional antibiotics,only sensitive to minocycline.The main Gram-positive bacteria were resistant to penicillin G and erythromycin,but sensitive to vancomycin.Candida albicans was sensitive to fluconazole,amphotericin B and flucytosine.Conclusion The main pathogenic bacteria in patients with respiratory infection are Gram-negative bacteria,the others are Gram-positive cocci and Fungi.The drug resistance rate of pathogens to conventional antibiotics is generally high.In the process of clinical diagnosis and treatment,we should make full use of microbiological laboratory to make drug sensitivity test on pathogenic bacteria,and then make sure to use drugs rationally according to the results of drug sensitivity.