下呼吸道感染痰分离菌细菌谱及耐药性分析  

Bacterial spectrum and drug resistance of bacteria isolated from patients with lower respiratory tract infections

作　　者：郎耀雄 许建英[1] 王淑峰[1] 杨芸[1] 

机构地区：[1]山西医学科学院山西大医院呼吸内科,山西太原030032

出　　处：《中华医院感染学杂志》2013年第5期1193-1195,共3页Chinese Journal of Nosocomiology

摘　　要：目的了解下呼吸道感染患者痰分离菌细菌谱及其对常用抗菌药物的耐药性,为临床合理使用抗菌药物提供依据。方法采用K-B进行抗菌药物敏感试验,结果按CLSI 2010年版判断。结果下呼吸道感染患者痰分离菌共520株,社区获得性下呼吸道感染(CALRTI)115株占22.1%;检出革兰阴性杆菌占75.7%,革兰阳性菌占24.3%;医院获得性下呼吸道感染(HALRTI)405株占77.9%;检出革兰阴性杆菌占76.3%,革兰阳性菌占23.7%;CALRTI中肺炎克雷伯菌检出率最高占34.8%;HALRTI中鲍氏不动杆菌检出率最高占23.7%;CALR-TI中多药耐药菌29株占25.2%;HALRTI 163株占40.2%;CALRTI金黄色葡萄球菌和凝固酶阴性葡萄球菌中甲氧西林耐药率为33.3%和81.8%;HALRTI中为69.4%和75.0%,葡萄球菌属中甲氧西林耐药株对抗菌药物(除磺胺甲噁唑/甲氧苄啶外)的耐药率显著高于敏感株(P<0.05),未出现对万古霉素耐药菌;屎肠球菌对多数药物的耐药率均高于粪肠球菌;CALRTI肺炎克雷伯菌、大肠埃希菌中产ESBLs株率为32.5%和42.9%,HAL-RTI中为60.8%和37.5%;产ESBLs株对多数抗菌药的耐药率显著高于非产ESBLs株(P<0.05);HALRTI中铜绿假单胞菌对美罗培南、亚胺培南耐药率为33.8%和36.9%,鲍氏不动杆菌为27.1%和36.5%;396株革兰阴性杆菌中检测出5株HALRTI泛耐药菌。结论在下呼吸道细菌感染中无论HALRTI还是CALRTI,均以革兰阴性杆菌为主要致病菌;总分离菌中多药耐药菌的检出率较高。OBJECTIVE To understand the bacterial spectrum of the bacteria isolated from the sputum of patients with lower respiratory tract infections so as to provide basis for the reasonable use of antibiotics.METHODS The drug susceptibility testing was performed with K-B method,and the results were determined according to the CLSI,2010.RESULTS Totally 520 strains of pathogens were isolated from the sputum of the patient with lower respiratory tract infections,there were 115（22.1%） strains of pathogens isolated from the patients with community-acquired lower respiratory tract infections（CALRTI）,the gram-negative bacilli accounted for 75.7%,and the gram-positive bacteria accounted for 24.3%.There were 405（77.9%） strains of pathogens causing hospital-acquired lower respiratory tract infections（HALRTI）,among which the gram-negative bacilli accounted for 76.3% and the gram-positive bacteria accounted for 23.7%.The isolation rate of Klebsiella pneumoniae causing CALRTI was the highest（34.8%）,and the isolation rate of the Acinetobacter baumannii was the highest（23.7%）.There were 163（40.2%） strains of pathogens causing HALRTI and 29（25.2%） strains of multidrug-resistant bacteria causing CALRTI.The drug resistance rates of Staphylococcus aureus and coagulase-negative Staphylococcus causing CALRTI to methicillin were 33.3% and 81.8%,69.4% and 75.0% of those strains causing HALRTI.The drug resistance rate of the methicillin-resistant Staphylococcus was significantly higher than that of the methicillin-sensitive Staphylococcus（except sulfamethoxazole / trimethoprim）（P0.05）,and there were no strains of vancomycin-resistant strains.The drug resistance rate of the multidrug-resistant Enterobacter faecalis was higher than that of Enterobacter faecium.The detection rates of the ESBLs-producing K.pneumoniae and Escherichia coli causing CALRTI were 32.5% and 42.9%,and 60.8% and 37.5% of HALRTI.The drug resistance rate of ESBLs-producing strains was significantly higher than that of the non-ESBLs-prod

关 键 词：细菌 药敏试验 耐药性 多药耐药菌 

分 类 号：R378[医药卫生—病原生物学]