慢性充血性心力衰竭患者下呼吸道感染的临床特点研究  

Clinical characteristics of chronic congestive heart failure patients with lower respiratory tract infections

作　　者：金功文[1] 李华平[1] 薛成年[1] 胡贤军[1] 

机构地区：[1]安徽医科大学附属巢湖医院心血管内科,安徽巢湖238000

出　　处：《中华医院感染学杂志》2013年第18期4378-4380,共3页Chinese Journal of Nosocomiology

基　　金：安徽省科技攻关项目(08010302180)

摘　　要：目的了解慢性充血性心力衰竭合并下呼吸道感染患者病原菌分布及药敏率,为正确选择抗菌药物治疗提供依据。方法选取2009年3月-2013年5月在心内科住院治疗的慢性充血性心力衰竭伴下呼吸道感染患者80例,送痰培养及药敏试验,分析病原菌的分布及药物敏感率。结果 80例患者共送检痰标本193次,培养出病原菌157株,其中革兰阳性菌49株、革兰阴性菌72株、真菌36株,分别占31.21%、45.86%、22.93%;革兰阳性菌对替考拉宁、亚胺培南、万古霉素的敏感性较高,>55.00%,对阿奇霉素、氧氟沙星、青霉素的敏感性低,<50.00%;革兰阴性菌72株对氨苄西林、头孢唑林、美罗培南、亚胺培南等敏感性高,>60.00%,对头孢噻肟、阿米卡星、氨曲南等敏感性低,<50.00%;真菌36株对酮康唑、氟康唑、伊曲康唑及伏立康唑的敏感性均为100.00%。结论革兰阴性菌是慢性充血性心力衰竭合并下呼吸道感染患者的主要病原菌,革兰阳性菌、革兰阴性菌对常用抗菌药物的敏感性有一定程度的下降,真菌比例有所上升,临床应根据药敏试验结果选用合理的抗菌药物。OBJECTIVE To understand the distribution and drug resistance of pathogens causing lower respiratory tract infections in patients with chronic congestive heart failure and analyze the drug susceptibility so as to guide the reasonable use of antibiotics. METHODS A total of 80 cases of chronic congestive heart failure patients complicated with lower respiratory tract infections, who were treated in the cardiology department from Mar 2009 to May 2013, were enrolled in the study, then the sputum specimens were submitted for bacterial culture, the drug susceptibility testing was performed, and the distribution and drug susceptibility of the pathogens were analyzed. RESULTS Of totally 193 sputum samples submitted from 80 patients, 157 strains of pathogens were isolated, ineluding 49（31.21%） strains of gram-positive bacteria, 72（45. 86%） strains of gram-negative bacteria, and 36 （22.93%） strains of fungi. The gram-positive bacteria were highly susceptible to teicoplanin, imipenem, and vancomycin, with the drug susceptibility rates more than 55.00 %, the drug susceptibility rate to azithromycin, ofloxacin, penicillin were less than 50.00% the 72 strains of gram-negative bacteria were highly sensitive to ampicillin,cefazolin, meropenem, imipenem, with the drug susceptibility rates more than 60.00%, and the drug suscep tibility rates to cefotaxime, amkacin, and aztreonam were less than 50.00% ; the drug susceptibility rates of the 36 strains of fungi to ketoconazole, fluconazole, itraconazole and voriconazole were 100.00%. CONCLUSION The gram-negative bacteria are the predominant pathogens causing the lower respiratory tract infections in the patients with chronic congestive heart failure; the drug susceptibility rates of the gram-positive bacteria and the gram-negative bacteria to the commonly used antibiotics are declined to some extent, the proportion of the fungi shows an upward trend. It is necessary to reasonably use antibiotics based on the result of drug susceptibility testing.

关 键 词：慢性心力衰竭 下呼吸道感染 病原菌 药敏 

分 类 号：R563.1[医药卫生—呼吸系统]