消化内科长期住院患者医院获得性肺部感染病原菌分布与耐药性研究  

Distribution and drug resistance of pathogens causing hospital-acquired pulmonary infections in long-term hospitalized patients of department of gastroenterology

作　　者：熊愫兵[1] 郑晓春[1] 杨蓉[2] 周蓉[3] 李少芳[1] 

机构地区：[1]枝江市人民医院消化内科,湖北枝江443200 [2]枝江市人民医院药剂科,湖北枝江443200 [3]枝江市人民医院院感科,湖北枝江443200

出　　处：《中华医院感染学杂志》2015年第14期3164-3166,共3页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(30900682)

摘　　要：目的研究消化内科长期住院患者医院获得性肺部感染的病原菌分布与耐药性,为合理应用抗菌药物提供依据。方法回顾性分析2009年1月-2014年7月消化内科长期住院患者发生医院获得性肺部感染患者的病原菌分布及耐药性。结果监测417例患者中发生医院获得性肺部感染82例,发生率19.67%;检出病原菌91株,其中革兰阴性菌57株占62.64%,革兰阳性菌21株占23.08%,真菌13株占14.28%,主要革兰阴性菌包括铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌和大肠埃希菌,其对亚胺培南敏感性较低,为18.75%-11.11%,而对氨苄西林/舒巴坦、头孢噻肟、哌拉西林/他唑巴坦、庆大霉素及环丙沙星的耐药性均较高88.89%-25.00%,主要革兰阳性菌有金黄色葡萄球菌、表皮葡萄球菌和肺炎链球菌,其对青霉素G耐药率100.00%,未发现对万古霉素耐药菌株;白色假丝酵母菌对抗真菌药物仍多为敏感。结论消化内科长期住院患者的医院获得性肺炎病原菌以革兰阴性菌为主,存在耐药性较高的状况,应根据药敏试验合理选择抗菌药物。OBJECTIVE To investigate the distribution and drug resistance of the pathogens causing hospital-acquired pulmonary infections in long-term hospitalized patients of department of gastroenterology so as to provide guidance for reasonable use of antibiotics.METHODS From Jan 2009 to Jul 2014,the distribution and drug resistance of the pathogens causing hospital-acquired pulmonary infections in the long-term hospitalized patients of department of gastroenterology were retrospectively analyzed.RESULTS Of 417 patients under the monitoring,82 cases had the hospital-acquired pulmonary infections,with the incidence of 19.67%.A total of 91 strains of pathogens have been isolated,including 57（62.64%）strains of gram-negative bacteria,21（23.08%）strains of gram-positive bacteria,and 13（14.28%）strains of fungi.The Pseudomonas aeruginosa,Klebsiella pneumoniae,Acinetobacter baumannii,and Escherichia coli were the major species of gram-negative bacilli,with the drug susceptibility rate to imipenem ranging from 18.75% to 11.11%;however,the drug resistance rates to ampicillinsulbactam,cefotaxime,piperacillin-tazobactam,gentamycin,and ciprofloxacin ranged from 88.89% to 25.00%.The Staphylococcus aureus,Staphylococcus epidermidis,and Streptococcus pneumoniae were dominant among the gram-positive bacteria,the drug resistance rate to penicillin G was 100.00%,and no vancomycin-resistant strain was found.Candida albicans remained susceptible to most of the antifungal agents.CONCLUSION The gram-negative bacteria are dominant among the pathogens causing hospital-acquired pneumonia in the long-term hospitalized patients of department of gastroenterology and are highly drug-resistant.It is necessary to reasonably use antibiotics based on the drug susceptibility testing.

关 键 词：消化内科 长期住院 患者 医院获得性肺部感染 耐药性 

分 类 号：R378[医药卫生—病原生物学]