呼吸内科门诊病房重症监护病房下呼吸道感染耐药菌分布及耐药率比较分析

Respiratory medicine outpatient wards RICU respiratory infections resistant bacteria distribution and resistance to the comparative analysis

目的对呼吸科不同区域下呼吸道感染耐药菌株的分布及耐药率进行比较分析,为当地耐药菌感染的控制提供早期治疗方案。方法采用K-B纸片扩散法和仪器法(VITEK-TWO),按照CLSI 2010年版标准判读结果,对2014年1—12月昆明医科大学第一附属医院呼吸科门诊、病房、呼吸重症监护病房(RICU)患者送检的痰液、肺泡灌洗液标本进行细菌分离鉴定及药敏试验,用WHONET5.6统计软件对数据进行分析。结果呼吸科3个不同区域下呼吸道感染耐药菌分布构成及耐药率存在明显差异,耐药菌分布前4位均以革兰阴性菌为主。肺炎克雷伯菌在RICU的耐药率高于呼吸科门诊和病房(P<0.05),对多数抗菌药物的耐药率>30%;大肠埃希菌在呼吸科三个不同区域对常用的抗菌药物耐药率相似;产ESBL菌株的多重耐药率明显高于非产酶株(P<0.05)。铜绿假单胞菌对喹诺酮类、氨基糖苷类、头孢吡肟、亚胺培南、头孢哌酮-舒巴坦、哌拉西林-他唑巴坦仍保持较高的抗菌活性,但RIIU的耐药率明显高于呼吸科门诊和病房(P<0.05);呼吸科病房、RICU与呼吸科门诊相比对鲍曼不动杆菌耐药率均较高,对亚胺培南的耐药率分别为64.6%、70.4%。RICU检出的MRSA对利福平耐药率较呼吸科门诊和病房明显升高(P<0.05)。结论呼吸科门诊、病房和RICU的耐药菌分布构成及耐药率均有明显差异,临床医师除了熟悉本地区耐药菌分布及耐药监测情况外,还应掌握本单位不同科室、本科室不同区域耐药菌的耐药率情况,才能正确有效合理选用抗菌药物。

Objective Lower respiratory tract in different areas in our respiratory infection of drug-resistant strains compares and analyses the distribution and resistance to provide local drug-resistant bacteria infection control early treatment. Methods From January 2014 to December 2014, using K-B disc diffusion method and the instrument method(VITEK- TWO), according to CLSI 2010 standard interpretation results, the first affiliated hospital of kunming medical university makes patients with respiratory outpatient and ward, RICU sputum bacterial strains,alveolar lavage fluid specimens for identification and drug sensitive test, use WHONET5.6 statistical software to analyze data.Results Respiratory three different regions of lower respiratory tract infection of drug-resistant bacteria and distribution percentages of obvious differences of drug-resistant bacteria distribution before four were mainly gram-negative bacteria. Klebsiella pneumoniae in RICU, higher percentages of respiratory outpatient and ward(P<0.05), for most antimicrobial drug resistant rate>30%; E. coli in respiratory three different areas are similar to commonly used antimicrobial resistance. Produce multiple resistance of ESBL strains was obviously higher than that of the enzyme production strains(P<0.05). Pseudomonas aeruginosa to quinolone, amino sugar glucoside, cefepime, imine south,cefoperazone/shu ba, and piperacillin/he azole remained higher antimicrobial activity, but RIIU significantly higher percentages of respiratory outpatient and ward(P<0.05). Respiratory ward, RICU compared with respiratory outpatient service of acinetobacter baumannii resistant rate are higher, the imine culture south of the percentages of 64.6%, 70.4% respectively. RICU detection of rifampin resistance of MRSA is respiratory outpatient and ward increased significantly(P<0.05). Conclusion Respiratory outpatient and ward and RICU drug-resistant bacteria distribution and resistance to all have obvious difference, clinicians in addition to the familiar with this area of drug-resistant bacteria distribution and drug resistance monitoring, but should also grasp the unit of different departments,undergraduate course room resistance of resistant bacteria in differentregions of the world situation, can effective reasonable choice of antimicrobial agents.