成人下呼吸道感染病原菌分布特征及耐药情况研究

Study on the Distribution Characteristics and Drug Resistance of Pathogens in Adult Lower Respiratory Tract Infection

目的:探讨成人下呼吸道感染病原菌分布特征及耐药情况,为临床治疗合理用药提供依据。方法:选取2018年8月—2020年9月焦作煤业(集团)有限责任公司中央医院收治的105例成人下呼吸道感染患者作为研究对象,均采集痰液分泌物样本,行病原菌培养和药敏试验,进行病原菌分离鉴定及耐药情况研究。结果:105份痰液分泌物标本中,共分离出114株病原菌;革兰氏阴性菌85株,占比为74.56%,以铜绿假单胞菌(27.19%)、肺炎克雷伯菌(20.18%)为主;革兰氏阳性菌27株,占比为23.68%,以肺炎链球菌(9.65%)、金黄色葡萄球菌(6.14%)为主;真菌2株,占比1.75%。铜绿假单胞菌对复方新诺明、奈替米星耐药率较高,对美罗培南无耐药性;肺炎克雷伯菌对头孢他啶、庆大霉素耐药率较高,对亚胺培南、美罗培南无耐药性;肺炎链球菌对四环素、红霉素、复方新诺明耐药率较高,对万古霉素、普考拉宁无耐药性;金黄色葡萄球菌对庆大霉素、红霉素耐药率较高,对普考拉宁、夫西地酸、万古霉素、四环素无耐药性。结论:成人下呼吸道感染病原菌分布以革兰氏阴性菌为主,其次为革兰氏阳性菌,且病原菌对不同抗菌药物耐药性存在差异,病原菌耐药性严峻,临床应严密监测、控制病原菌耐药性,按照药敏结果科学使用抗生素药物进行治疗,有利于确保临床合理用药,提高抗感染效果。

Objective:To investigate the distribution of pathogens and resistance of lower respiratory infection.Methods:105 adult patients with lower respiratory tract infections admitted to the hospital from August 2018 to September 2020 were selected as study subjects,and all sputum secretion samples were collected.Pathogenic bacteria culture and drug sensitivity tests were performed,and the isolation and identification of pathogenic bacteria and drug resistance were studied.Results:A total of 114 pathogenic strains were isolated from 105 sputum secretion specimens.Gram-negative bacteria were 85 strains,accounting for 74.56%,dominated by Pseudomonas aeruginosa(27.19%)and Klebsiella pneumoniae(20.18%).There were 27 strains of Gram-positive bacteria,accounting for 23.68%,dominated by Streptococcus pneumoniae(9.65%)and Staphylococcus aureus(6.14%),2 strains of fungi,accounting for 1.75%.Pseudomonas aeruginosa showed a high rate of resistance to cotrimoxazole and nitisin,and no resistance to meropenem.Klebsiella pneumoniae had high resistance to ceftazidime and gentamicin,and no resistance to imipenem and meropenem.Streptococcus pneumoniae had a high rate of resistance to tetracycline,erythromycin and cotrimoxazole,and no resistance to vancomycin and puccolainin.Staphylococcus aureus had higher resistance rate to gentamicin and erythromycin,and no resistance to puccolain,fusidic acid,vancomycin and tetracycline.Conclusion:The distribution of pathogenic bacteria in adult lower respiratory tract infections is dominated by Gram-negative bacteria,followed by Gram-positive bacteria,and there are differences in the resistance of pathogenic bacteria to different antibacterial drugs.The pathogenic bacteria resistance is serious,the clinical should closely monitor and control the pathogenic bacteria resistance,according to the drug sensitivity results of scientific use of antibiotic drugs for treatment,which is conducive to ensure the rational use of clinical drugs and improve the anti-infective effect.