呼吸道定植菌与病原菌耐药率比较分析  

Comparative analysis of drug resistance rate between colonized bacteria and pathogenic bacteria isolated from respiratory tract

作　　者：陈会[1] 孙敬[1] 兰玉娟[2] 邓林强[1] 余理智[1] 熊章华[1] 

机构地区：[1]江西省人民医院检验科,南昌330006 [2]江西省人民医院感染科,南昌330006

出　　处：《实验与检验医学》2008年第4期355-358,共4页Experimental and Laboratory Medicine

摘　　要：目的比较分析典型的呼吸道定植菌和典型的病原菌对常用抗生素的耐药率的不同。方法依据一定判断标准,从1486株革兰阴性菌中遴选出典型的定植菌392株(肠杆菌科219株,非发酵菌173株)及典型的病原菌504株(肠杆菌科323株,非发酵菌181株),比较两者对9种常用抗生素耐药率的不同。并对其中大肠埃希菌、肺炎克雷伯菌及奇异变形菌进行ESBLs确证实验,比较定植菌和病原菌之间ESBLs阳性率的不同。结果肠杆菌科细菌中,定植菌和病原菌对亚胺培南耐药率相同,对其它抗生素,定植菌的耐药率均显著高于病原菌;非发酵菌中,定植菌和病原菌对左旋氧氟沙星的耐药性比较差异无显著性,对其它抗生素,定植菌的耐药率均显著高于病原菌。426株大肠埃希菌、肺炎克雷伯菌及奇异变形菌中,定植菌ESBL阳性率显著高于病原菌。结论呼吸道定植菌对常用抗生素的耐药性显著高于病原菌,实验室一方面应提高抗生素使用前咳痰标本送检率;另一方面,在进行耐药统计之前,应对咳痰标本培养出的条件致病菌的临床意义仔细甄别,剔除定植菌株。尽可能避免偏倚,高估呼吸道医院内感染的耐药率。Objective To compare the different resistance rate to commonly used antibiotics between typical colonized bacteria and pathogenic bacteria isolated from respiratory tract. Methods According to certain stantard, 392 strains of typical colonized bacteria （219 strains of enterobactericaeae, 173 strains of non-fermenter） and 504 strains of typical pathogenic bacteria （323 strains of enterobactericaeae, 181 strains of non-fermenter） were selected from 1486 strains of gram-negative bacilli isolated from respiratory tract. Antimicrobial susceptibility of the two kinds of bacilli was tested by Kirby-Bauer method. For Escherichia coli., Klebsierlla pneumonia and Proteus mirabillis, ESBL confirmatory test was performed according to the guidelines of CLSI （2006）. Results Compared with pathogenic bacteria, colonized bacteria had significant higher resistance rate with the exception to imipenem （enter- obactericaeae） and levofloxacin （non-fermenter）, colonized bacteria showed sighificant higher ESBL positive rate than pathogenic bacteria among 426 strains of Escherichia coli., Klebsierlla pneumonia and Proteus mirabillis. Conclusions Colonized bacteria of respiratory tract had higher ersistance rate than pathogenic bacteria. For conditioned pathogen isolated from sputum, laboratory should discriminate pathogenic bacteria from colonized bacteria.

关 键 词：痰 定植菌 病原菌 耐药 

分 类 号：R446.5[医药卫生—诊断学] Q939.92[医药卫生—临床医学]