下呼吸道医院感染病原菌分布及耐药性研究  

Clinical Bacterial Distribution and Analysis of Drug Resistance in Lower Respiratory Tract Nosocomial Infection

作　　者：周宏[1] 任玲[1] 韩方正[1] 茅一平[1] 康海全[1] 

机构地区：[1]江苏省徐州医学院附属医院感染管理科,江苏徐州221002

出　　处：《中华医院感染学杂志》2008年第12期1790-1792,共3页Chinese Journal of Nosocomiology

基　　金：江苏省卫生厅医学科技发展基金项目(P200508)

摘　　要：目的了解下呼吸道医院感染的病原菌分布及常见病原菌的耐药情况。方法采用前瞻性调查的方法进行医院感染病例监测,并对发生下呼吸道医院感染的351例患者呼吸道分泌物进行细菌培养和药敏试验。结果351例痰标本中共检出病原菌346株,主要病原菌依次为铜绿假单胞菌、大肠埃希菌、克雷伯菌属和金黄色葡萄球菌;大肠埃希菌和克雷伯菌属中产超广谱β-内酰胺酶(ESBLs)的比率较高,分别为36.0%和40.0%,金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌(MRSA)占82.1%;且不论是革兰阴性杆菌还是革兰阳性球菌均表现出了极高的多药耐药性,革兰阴性杆菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦和亚胺培南的耐药率较低,金黄色葡萄球菌、表皮葡萄球菌和肠球菌属对万古霉素均未出现耐药现象。结论下呼吸道分离病原菌耐药现象普遍存在,临床应重视病原学检查,开展病原菌耐药性监测,合理使用抗菌药物。OBJECTIVE To analyze the bacterial distribution and drug resistance in lower respiratory tract nosocomial infection（NI）. METHODS To investigate 351 patients suffered from lower respiratory tract NI using the prospective monitoring methods, and doing the pathogenic bacterium cultivation for sputums of 351 patients and then taking the susceptibility test. RESULTS Totally 346 pathogenic bacteria were found in sputums of 351 patients. The major pathogenic bacteria were Pseudornonas aeruginosa, Escherichia coli, Klebsiella and Staphy- lococcus aureus. ESBLs were 36.0% and 40.0%, respectively in E. coli and Klebsiella, and MRSA were 82.1% in S. aureus. Drug resistances were common in Gram-negative bacilli （GNB） and Gram-positive cocci. Piperacillin/tazobactam and cefoperazone/sulbaetam and imipenem were the most sensitive for GNB, S. aureus, S. epidermidis and Enterococcus were all sensitive to vancomycin. CONCLUSIONS Drug resistance of the pathogenic bacteria in lower respiratory tract NI is common, so it＇s necessary to emphasize pathogenic bacterium monitoring and use the antibacterials exactly.

关 键 词：下呼吸道医院感染 病原菌 耐药性 抗菌药物 

分 类 号：R978.1[医药卫生—药品]