医院获得性肺炎痰菌培养结果分析  

Pathogens and drug resistance in patients with hospital-acquired pneumonia

作　　者：宁波[1] 魏璇[1] 王新宴[1] 张虎[1] 马建珍[1] 

机构地区：[1]北京空军总医院ICU,100036

出　　处：《国际呼吸杂志》2007年第8期564-566,共3页International Journal of Respiration

摘　　要：目的了解医院获得性肺炎致病菌的分布特点及耐药性，有利于早期经验性使用抗生素。方法分析2004年1月至2006年4月医院获得性肺炎患者114例，其中合并多脏器功能衰竭患者56例，未合并多器官功能衰竭患者58例，自患者痰液分离致病菌，并分析药敏实验结果。结果合并多器官功能衰竭患者（n=56）痰培养分离致病菌依次为嗜麦芽窄食单胞菌、阴沟肠杆菌、粪肠球菌、金黄色葡萄球菌、大肠埃希氏菌；未合并多器官功能衰竭患者（n=58）痰培养分离致病菌依次为铜绿假单胞菌、金黄色葡萄球菌、大肠埃希氏菌、表皮葡萄球菌、粪肠球菌。合并多脏器功能衰竭患者致病菌耐药率与未合并多器官衰竭者比较差异显著（P〈0．01）。对革兰阴性杆菌耐药率小的抗生素依次为亚胺培南（32.8％）、阿米卡星（32．8％）、头孢派酮＋舒巴坦（35．4％）；对革兰阳性球菌耐药率依次为万古霉素（15．4％）、四环素（54．1％）、复方新诺明（61．8％）。结论①医院获得性肺炎合并多器官功能衰竭时多为耐药菌感染，耐药性比未合并多器官功能衰竭者高。②多器官功能衰竭时耐药菌导致肺部感染可能是患者死亡率高的原因之一。③万古霉素、亚胺培南、阿米卡星、头孢哌酮＋舒巴坦仍是治疗耐药菌感染的强效药物。Objective To study the features of isolated bacteria from sputum specimens in the patients with hospital-acquired pneumonia （HAP）. Methods The bacteriology of the patients with HAP or accompanied with multiple organ dysfunction syndrome（MODS） between Jan. 2004 and Apr. 2006 in the hospital were analyzed. Results The five most common isolated bacteria were Steotrophomonas maltophilia, Enterobacter cloacae,Eenterococcus faecalis,Staphylococcus aureus and Escherichia coli in the patients with HAP with MODS （ n = 56）. The five most common isolated bacteria were Pseudomonas aeruginosa, Staphylococcus aureus, Esc.herichia coli, Staphylococcus epidermidis and Eenterococcus faecali in the patients with HAP without MODS（ n = 58）. All the bacillus of the patients with HAP with MODS showed quite higher drug resisitance rate than those of the patients with HAP without MODS. The active agents against gram negative organisms were imipenem, amikacin, cefoperazone and sulbactam. Vancomycin, tetracycline, SMZco were active for the gram positive bacillus. Conclusions The drug resistance rate of clinical bacteria in the patients with HAP with MODS were higher than with HAP without MODS. Vancomycin, imipenem, amikacin,cefoperazone and sulbactam were main choice to patients with HAP.

关 键 词：多器官功能衰竭 医院获得性肺炎 抗药性 

分 类 号：R446[医药卫生—诊断学] R563[医药卫生—临床医学] R45