难治性肺部感染患者病原菌分布及耐药性分析  

Species and Drug Resistance of the Pathogenic Bacteria in Patients with Refractory Pulmonary Infection

作　　者：卓安山[1] 曾葭[1] 李奕[1] 童皖宁[1] 谢仁春[1] 董洁[1] 徐永银[1] 

机构地区：[1]海军四一一医院呼吸科,上海市200081

出　　处：《中华全科医学》2011年第12期1887-1888,共2页Chinese Journal of General Practice

摘　　要：目的探讨海军四一一医院难治性肺部感染患者的病原菌分布及其耐药性,为临床合理用药提供依据。方法对2005年1月-2010年12月间住院的110例难治性肺部感染患者,通过支气管镜采集痰标本进行细菌培养和药敏试验。结果 110例患者共采集痰标本487份,获病原菌310株,阳性率为63.6%。其中革兰阴性杆菌占66.5%,革兰阳性球菌占16.1%,真菌占16.7%。病原菌主要为肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、金黄色葡萄球菌和白假丝酵母菌。87.3%患者存在混合感染。两类病原菌的耐药率普遍较高,有多重耐药趋势,革兰阴性杆菌对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦和亚胺培南的敏感性较高,革兰阳性球菌对万古霉素和甲氧苄啶/磺胺甲噁唑的敏感性较高。结论本组难治性肺部感染患者以多重耐药菌和/或混合感染为主,病原菌具有广泛的耐药率,临床上对肺部感染患者应特别重视病原学诊断,根据药敏试验合理使用抗生素。Objective To investigate the pathogenic bacteria and drug resistance to antibiotics in patients with refractory pulmonary infection in our hospital,and to provide reference for clinical treatment.Methods The sputum specimens were collected by bronchoscopy from 110 patients with refractory pulmonary infection between Jan.2005 and Dec.2010.Results Total 487 samples were collected from 110 patients,310 strains of bacteria were isolated,the positive rate was about 63.6%.Gram negative bacilli（G-） of them accounted for 66.5%,gram positive cocci（G＋） occupied 16.1%,and fungi occupied 16.7%.Among the isolated strains,the main pathogenic bacteria were klebsiella pneumonia（25.2%）,pseudomonas aeruginosa（18.4%）,Acinetobacter baumannii（11.9%）,staphylococcus aureus（7.8%）,and candela albicans（14.2%）.87.3% of them were mixed infection.The drug-sensitivity test showed that these pathogens were multidrug resistant.The sensitive drugs of G-strains were impenem,cefoperazone/sulbactam and piperacillin/tazobactum.The sensitive drugs of G＋ strains were vancomycin and trimethoprim/sulfamethoxazole.Conclusion The patients with refractory pulmonary infection were infected by multidrug resistant and mixed microorganisms.The patients with pulmonary infection must lay highly stress on etiologic diagnosis.Antibiotics administration must be based on the drug sensitive test.

关 键 词：难治性肺部感染 病原菌 痰培养 药敏试验 耐药率 

分 类 号：R563.1[医药卫生—呼吸系统] R446.54[医药卫生—内科学]