下呼吸道革兰阴性菌感染的病原学及耐药分析  

Study on the Distribution and Drug Resistance of Gram-negative Bacteria in Patients with Lower Respiratory Tract Infection

作　　者：杨泽刚[1] 王天立[1] 裴文军[1] 杨翠云[1] 胡成平[2] 

机构地区：[1]湖南省常德市第一人民医院,湖南常德415003 [2]中南大学湘雅医院呼吸科,湖南长沙410000

出　　处：《医学临床研究》2006年第10期1628-1630,共3页Journal of Clinical Research

摘　　要：【目的】了解本地区下呼吸道革兰阴性菌(G-)感染者的病原学诊断及对常用抗生素的敏感情况。【方法】回顾性分析2002年1月至2004年12月本院下呼吸道感染住院患者痰标本细菌培养分离及药敏试验结果。【结果】分离率前五位的菌种分别为铜绿假单胞菌(34.8%)、不动杆菌(13.5%)、肺炎克雷伯菌(12.9%)、大肠埃希菌(12.3%)和阴沟肠杆菌(5.2%)。所有G-均有较严重的耐药性,除头孢他啶外,对多数头孢三代药物耐药率高。耐药率较低的抗生素有亚胺培南、美洛培南、哌拉西林/他唑巴坦、头孢吡肟、左氟沙星。其中碳青霉烯类抗生素(亚胺培南、美洛培南)对下呼吸道G-的敏感率在95%以上。本组分离的下呼吸道G-对左氟沙星耐药率较低(33%),对阿米卡星的耐药率高(46%),与其他地区的报道存在较大差异。【结论】下呼吸道G-感染的耐药是目前临床上面临的难题,值得进一步研究,应采用合理的手段降低耐药率的发生。[Objective]To investigate the distribution of drug resistance of gram-negative bacteria in patients with lower respiratory tract infection in Changde city. [Methods]The results of sputum＇s culture and antimicrobial susceptibility of patients from 2002 to 2004 were reviewed. [Results]The most common pathogens were Pseudomonas aeruginosa （ 34.8 % ）, Acinetobacter spp （ 13.5 % ）, Klebsiella pneumoniae （ 12.9 % ）, Escherichia coli （12.3 % ）, Enterobacter cloacae（5.2 % ）. High drug-resistance rates were found among all strains of pathogens to the third generation cephalosporins except ceftazidime. The most sensitive agents against Gram negative organisms were carbopenems（Imipenem, Meropenem）, with a susceptibility of more than 95%, followed by Piperacilline/Tazobactam, Cefepime and Levofloxacin. In this study, the drug-resistance rate among gram-negative bacteria from lower respiratory tract to Levofloxacin was 33%, while drug-resistance rate to amikacin was 46% ,different from reports of other area. [Conclusion]Drug resistance is still a serious clinical problem. An unanimous effective strategy for the solution of this problem is urgently needed.

关 键 词：呼吸道感染 革兰氏阴性菌 抗药性 微生物 

分 类 号：R517.6[医药卫生—内科学]