2004～2005年我院下呼吸道感染病原菌分布及耐药性分析  

ANALYSIS OF DISTRIBUTION AND DRUG RESISTANCE OF PATHOGENS IN LOWER RESPIRATORY TRACT INFECTION BETWEEN THE YEAR OF 2004 AND 2005 IN OUR HOSPITAL

作　　者：所鸿[1] 张志敏[2] 易青[2] 董京生[1] 

机构地区：[1]内蒙古医学院附属医院呼吸内科,内蒙古呼和浩特010050 [2]内蒙古医学院附属医院检验科,内蒙古呼和浩特010050

出　　处：《内蒙古医学院学报》2007年第5期335-339,共5页Acta Academiae Medicinae Neimongol

基　　金：内蒙古自治区高校科学研究项目(NG06121)

摘　　要：目的：了解我院呼吸科住院病人下呼吸道感染的病原菌分布和耐药情况，为临床用药提供参考。方法：采用纸片扩散法对2004—01～2005—12我院呼吸科下呼吸道感染的住院病人痰培养阳性的病原菌进行药敏检测，按NCCLS 2003年版标准判断结果，同时对结果进行回顾性分析。结果：2a中分离出538株革兰氏阴性菌，其中以大肠埃希氏杆菌、阴沟气杆菌、绿脓假单胞菌以及肺炎克雷白杆菌为主；64株革兰氏阳性菌，以金黄色葡萄球菌和表皮葡萄球菌为主；耐药分析显示主要革兰氏阴性菌对亚氨培南（100％）、头孢哌酮-舒巴坦（80.7％）敏感性高，其他依次为阿米卡星（59．1％）、左氧氟沙星（56．1％）、头孢他啶（53．8％）；大肠埃希氏杆菌、阴沟气杆菌、肺炎克雷白杆菌中产ESBLs菌株，分别为30．4％、24．4％及29．7％；产酶菌株对除碳青酶烯类之外抗菌剂耐药率明显高于非产酶菌株，产酶菌株对亚氨培南、头孢哌酮／舒巴坦敏感性好，对阿米卡星、左氧氟沙星次之，对三代头孢高度耐药。结论：近2a来我院呼吸科下呼吸道感染住院病人的主要致病菌，是以大肠埃希氏杆菌、阴沟气杆菌、绿脓假单胞菌以及肺炎克雷白杆菌为主的革兰氏阴性菌，产ESBLs菌株的增多是革兰氏阴性菌耐药的重要原因之一，临床应合理应用抗生素。以防细菌耐药性的发生。Objective：To guide the clinical drug use by studying the distribution of pathogens isolated from patients with lower respiratory tract infection in department of respiratory medicine between the year of 2004 to 2005 in our hospital. Methods： All the clinical isolates from sputum from January 2004 to December 2005 were analyzed retrospectively. Antibiotic sensitivity was tested by Kirby -Bauer method. The results were interpreted according to NCCLS 2003. Results： A total of 848 clinical isolates strains were collected, including 538 strains of Gram- negative and 64 strains of Gram -positive. The most important Gram -negative pathogens were Escherichia coli, Aerobaeter cloacae, Pseudomonas aeruginosa, Klebsiella pneumoniae. The most common Gram - positive was Staphylococcus aureus. Most strains of Gram - negative were sensitive to imipenem（ 100% ） and cefoperazone - sulbactam. （80.7%）. The sensitivity rate of Gram - negative to amikacin, levofloxacin and ceftazidime were 59.1% , 56.1% and 53.8% ,respectively. About 30.4% of E. coli, 24.4% of Aerobacter and 29.7% of Klebsiella sp. isolates were extended - spectrum β - lactamases （ESBLs） producers. The resistance rate of ESBLs producing strains to most antibiotics was much higher than those of non - ESBLs producing strains. The sensitivity rate of ESBLs producing strains to imipenem and cefoperazone - sulbactam were higher than other antibacterial agents. Conclusion：Gram -negative bacteria are still the leading pathogens in lower respiratory tract infection during the last 2 years in our department of respiratory medicine. The increase in ESBLs positive pathogens is one of the reasons for higher resistance. Rational use of antibiotics is important for the containment of bacterial resistance.

关 键 词：下呼吸道感染 病原菌 抗生素 耐药性 

分 类 号：R562[医药卫生—呼吸系统]