下呼吸道感染病原菌变迁及耐药状况分析  

Analysis of pathogen distribution change and drug resistance in low respiratory tract infection

作　　者：王艳丽[1] 黄茂[1] 王文晶[2] 梅亚宁[3] 

机构地区：[1]南京医科大学第一附属医院呼吸科,江苏南京210029 [2]南京医科大学附属南京第一医院呼吸科,江苏南京210006 [3]南京医科大学第一附属医院检验科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2008年第3期321-326,共6页Journal of Nanjing Medical University(Natural Sciences)

摘　　要：目的:了解下呼吸道感染病原菌的变迁、主要流行病原菌的耐药状况,为临床合理应用抗菌药物提供依据。方法:用WHONET5.3软件统计分析2005～2006年南京医科大学第一附属医院住院患者痰液培养标本及药敏结果。结果:革兰阴性菌占所有非重复阳性标本的51.1%;其次为真菌占33.7%。所有病原菌中,白色念珠菌位居第一,铜绿假单胞菌、不动杆菌属、肺炎克雷伯菌亦较为常见,常见细菌的耐药菌株比例较高。2006年不动杆菌属、大肠埃希菌占所有病原菌比例较2005年明显升高。产超广谱β-内酰胺酶(extended-spectrumbeta-lactamase,ESBLs)菌株检出率为8.3%,大肠埃希菌、肺炎克雷伯菌产ESBLs比例在两年间亦有显著性变化,对第三、四代头孢菌素及氟喹诺酮类耐药比例较高。2006年耐甲氧西林葡萄球菌(methicillin-resistantstaphylococcus,MRS)检出率明显高于2005年,占所有葡萄球菌的59%,对大环内酯类、氟喹诺酮类及头孢菌素类呈现高度耐药。结论:目前下呼吸道感染病原菌中多药耐药比例逐年增加,针对产ESBLs菌株建议选用碳青霉烯类,对MRS推荐用万古霉素。Objective：To investigate the distribution change and drug resistance of common and special pathogens in low respiratory infection for providing evidence of clinical anti-infection therapy. Methods：The results of 13 463 sputum cultures tested in inpatients during the period 2005～2006 and the drug susceptibility of pathogens were analyzed by the software WHONET5.3. Results： Among all pathogens in low respiratory tract infection, gram-negative bacteria accounted for 51.1% while fungi accounted for 33.7%. Candida albicans stood the first, and Pseudomonas aeruginosa,Acinetobacter sp ,Klebsiella pneumoniae were common pathogens. The rate of A cinetobacter sp, Escherichia coli in 2006 increased significantly compared with that in 2005. Among all gram-negative bacteria, ESBLs-producing strains accounted for 8.3% and had high resistance to the third and forth generation cephalosporins and fluoro quinolones. The differences of ESBLs-producing rates of Escherichia coli and Klebsiella pneumoniae between the two years were significant. MRS accounted for 59% of all staphylococci, resisting to macrolids, cephalosporins and fluoroquinolones. The rate of MRS was significantly higher in 2006 than in 2005. Conclusion：the percentage of multidrug resistant pathogens in low respiratory tract infection increased with time. Carbopenems were recommended for ESBLs-producing pathogens and Vancomycin for MRS.

关 键 词：下呼吸道感染 病原菌 耐药 超广谱Β-内酰胺酶 耐甲氧西林的葡萄球菌 

分 类 号：R378[医药卫生—病原生物学]