呼吸道常见感染病原菌及其耐药性分析

Analysis of Common Pathogens of Respiratory Tract Infection and Their Drug Resistance

目的总结呼吸道的常见感染病原菌,总结相关病原菌抗菌药物不合理用药的因素,分析耐药性。方法将2019年1月至2020年6月到我院进行治疗并发生院内感染的143例患者作为研究对象,对所有患者临床资料做出回顾性分析,研究出现呼吸道感染的患者人数,分析呼吸道感染相关抗菌药物用药的不合理因素,总结呼吸道感染的主要病原菌分布和耐药性等。结果①同期院内143例感染患者中出现不良表现的患者48例,占33.57%。且143例感染者中有呼吸道感染患者53例,占37.06%,其中上呼吸道感染患者18例,占33.96%,下呼吸道感染患者35例,占66.04%。②用药时间≥3 d、用药滴速≥35滴/min、忽视药物过敏史、输液中药物浓度较高、用药剂量差错、联合用药不当、停药不及时、未开展药敏试验、换药频繁、用药途径差错、处方适应证不匹配、医嘱标注不准确等属于呼吸道感染不合理用药的单因素,满足统计学差异(P<0.05)。③用药滴速≥35滴/min、忽视药物过敏史、联合用药不当、医嘱标注不准确等属于呼吸道感染不合理用药的独立危险因素,满足统计学差异(P<0.05)。④金黄色葡萄球菌、表皮葡萄球菌等革兰阳性菌主要耐药多种β-内酰胺类抗生素(头孢类、青霉素类)、个别喹诺酮类抗生素(洛美沙星),耐药性均在60%以上,敏感的抗生素为万古霉素和米诺环素;对于铜绿假单胞菌、肺炎克雷伯菌等普遍耐药多种β-内酰胺类抗生素,耐药性能达到70%以上,而对庆大霉素、头孢他定、多黏菌素具有较高的敏感性。结论医院导致患者出现呼吸道感染的常见病原菌种类较多,治呼吸道感染用药不合理的因素表现为多个方面,而且大部分致病菌对常见的抗生素普遍具有较高的耐药性,治疗时应根据患者的药敏试验结果正确选择药物,增强抗菌药物用药的合理性,避免滥用抗生素而导致患者病情严重化。

Objective To summarize the common infectious pathogens of the respiratory tract,summarize the factors of irrational use of antibiotics in related pathogens,and analyze the drug resistance.Methods One hundred and forty-three patients who came to our hospital for treatment and developed nosocomial infection from January 2019 to June 2020 were selected as the research subjects,and the clinical data of all patients were retrospectively analyzed.The irrational factors of antibiotic use,and the main pathogenic bacteria distribution and drug resistance of respiratory tract infections are summarized.Results(1)Among the 143 infected patients in the hospital during the same period,48 patients had adverse manifestations,accounting for 33.57%.And among the 143 infected persons,there were 53 patients with respiratory tract infection,accounting for 37.06%,including 18 patients with upper respiratory tract infection,accounting for 33.96%,and 35 patients with lower respiratory tract infection,accounting for 66.04%.(2)Medication time≥3 days,medication dropping rate≥35 drops/min,ignoring the history of drug allergy,high drug concentration in the infusion,wrong drug dosage,improper combination medication,untimely drug withdrawal,no drug susceptibility test,frequent drug change,wrong drug route,and inappropriate prescription indications matching,inaccurate labeling of doctor's orders,etc.belong to the single factors of irrational drug use of respiratory tract infection,which meet the statistical difference(P<0.05).(3)Medication dropping rate≥35 drops/min,neglect of drug allergy history,improper combination medication,inaccurate labeling of doctor's orders,etc.,were independent risk factors for irrational drug use of respiratory tract infections,which met statistical differences(P<0.05).(4)Gram-positive bacteria such as staphylococcus aureus and staphylococcus epidermidis were mainly resistant to a variety ofβ-lactam antibiotics(cephalosporins,penicillins),individual quinolone antibiotics(lomefloxacin),drug resistance is above 60%,sensitive antibiotics are vancomycin and minocycline;for pseudomonas aeruginosa,klebsiella pneumoniae primary bacteria are generally resistant to a variety ofβ-lactam antibiotics,and the drug resistance reaches more than 70%,while they are highly sensitive to gentamicin,ceftazidine,and polymyxin.Conclusion There are many kinds of common pathogenic bacteria that cause respiratory tract infection in patients in hospital.The factors of unreasonable drug use for respiratory tract infection are manifested in many aspects,and most pathogenic bacteria generally have high resistance to common antibiotics.According to the patient's drug susceptibility test results,the drug should be correctly selected to enhance the rationality of antibiotic use,and to avoid the abuse of antibiotics and lead to the seriousness of the patient's condition.