呼吸道分泌物中分离菌的分布及耐药性分析  

Distribution and antimicrobial resistance of common pathogens isolated from respiratory secretion

作　　者：刘彩林[1] 朱旭慧[1] 孙自镛[1] 李丽[1] 张蓓[1] 陈中举[1] 田磊[1] 王斌[1] 朱琴[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院检验科,武汉430030

出　　处：《中国感染与化疗杂志》2011年第3期219-223,共5页Chinese Journal of Infection and Chemotherapy

摘　　要：目的了解华中科技大学同济医学院附属同济医院呼吸道病原菌的分布及耐药特征,为临床合理使用抗菌药物、有效控制呼吸道感染提供依据。方法回顾分析该院2009年1月1日—12月31日痰标本分离菌分布情况,按照CLSI2009年标准判读结果,用WHONET5.4软件进行结果分析。结果共分离出3 032株病原菌,其中革兰阴性杆菌占74.1%,革兰阳性球菌占15.7%,真菌占10.2%。排名前10位的分离菌依次为肺炎克雷伯菌（13.8%）、鲍曼不动杆菌（12.7%）、金葡菌（12.1%）、铜绿假单胞菌（11.7%）、大肠埃希菌（7.0%）、嗜麦芽窄食单胞菌（4.9%）、白念珠菌（4.8%）、流感嗜血杆菌（4.3%）、肺炎链球菌（3.5%）和阴沟肠杆菌（3.1%）。门诊患者流感嗜血杆菌检出率较高。药敏试验结果显示,鲍曼不动杆菌对头孢哌酮-舒巴坦耐药率低,为7.3%,中介率较高,为39.1%,对其他药物的敏感率均在40%以下;铜绿假单胞菌对常用抗菌药物耐药率较高,为12.1%~89.4%;流感嗜血杆菌和肺炎链球菌对青霉素类抗生素敏感率仅为60%~70%,儿童株耐药性普遍高于成人株。肺炎克雷伯菌和大肠埃希菌产ESBLs率分别为52.6%和88.6%;MRSA检出率为75.1%。ICU和呼吸科多重耐药菌株最常见,其次为儿科。结论该院呼吸道分离菌以条件致病菌为主,其中苛养菌占7.8%。细菌耐药现象严重,临床医师应根据药敏试验结果合理使用抗菌药物。Objective To investigate the distribution and antibiotic resistance of pathogens isolated from respiratory tract and provide the basis for effectively control of respiratory infections and reasonably use of antimicrobial agents.MethodsThe distribution of pathogens isolated from respiratory tract in our hospital was reviewed retrospectively from January 1,2009 to December 31,2009 according to CLSI 2009.Antibiotic resistance was analyzed with WHONET 5.4 software.ResultsA total of 3 032 strains of microorganisms were collected,of which gram-negative bacillus accounted for 74.1%,gram-positive coccus 15.7%,and fungus 10.2%.The top 10 species of pathogens were K.pneumoniae（13.8%）,A.baumannii（12.7%）,S.aureus（12.1%）,P.aeruginosa（11.7%）,E.coli（7.0%）,S.maltophilia（4.9%）,C.albicans（4.8%）,H.influenza（4.3%）,S.pneumoniae（3.5%） and E.cloacae（3.1%）.The prevalence of H.influenzae was high in outpatients.A.baumannii strains showed relatively lower resistance to cefoperazone-sulbactam（7.3%）,but about 39.1% of these strains showed intermediate resistance.Not more than 40% of A.baumannii strains were susceptible to other antimicrobial agents tested.P.aeruginosa isolates were highly resistant.The resistance rate ranged from 12.1% to 89.4%.Only 60%-70% of H.influenzae and S.pneumoniae isolates were susceptible to penicillins.The strains isolated from children were more resistant than those from adults.The prevalence of ESBLs-producing strains was 52.6% and 88.6% in K.pneumoniae and E.coli.The prevalence of MRSA was 75.1%.Multi-drug resistant strains were most common in ICU and Department of Respiratory Diseases,followed by Pediatrics.ConclusionsThe microbial isolates in our hospital during 2009 are mainly opportunistic pathogens.About 7.8% are fastidious bacteria.Most strains were resistant to multiple antibiotics.It is suggested that clinicians should use antibiotics rationally according to the results of susceptibility testing.

关 键 词：病原菌 呼吸道感染 耐药性 药敏试验 

分 类 号：R446.5[医药卫生—诊断学]