医院获得性阻塞性肺炎患者下呼吸道感染苛养菌分布及耐药特征分析  

Distribution and drug resistance analysis of fastidious bacteria caused obstructive pneumonia in patients with lower respiratory tract hospital acquired infection

作　　者：刘广义[1] 刘畅畅[2] 王锡波[3] 刘冰[4] 战松梅[5] 王红兵[5] 李建玲[6] 

机构地区：[1]青岛大学附属医院脑血管病研究所,山东青岛266003 [2]青岛大学附属医院医学动物实验室,山东青岛266071 [3]青岛大学附属医院检验科,山东青岛266071 [4]青岛医院内科,山东青岛266071 [5]青岛医院药房,山东青岛266071 [6]山东省公安消防总队医院门诊部,山东济南250101

出　　处：《中华医院感染学杂志》2016年第14期3155-3157,共3页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(30171113)

摘　　要：目的探讨医院获得性阻塞性肺炎下呼吸道感染苛养菌的分布及耐药性特点,为合理使用抗菌药物提供临床治疗依据。方法用巧克力培养基对来自临床各科室的标本进行分离培养,用卫星现象鉴别流感嗜血杆菌;采用纸片扩散法进行19种抗菌药物的药敏试验,根据美国临床实验室标准化研究所(CLSI)药敏试验指南判断;头孢硝噻吩纸片法检测菌株β-内酰胺酶产生情况。结果流感嗜血杆菌对莫西沙星、左氧氟沙星、亚胺培南100%敏感;而对氨苄西林/舒巴坦、头孢呋辛、阿奇霉素的耐药率分别为93.08%、66.86%和95.38%;卡他莫拉菌对3、4代头孢菌素、氨苄西林/舒巴坦、亚胺培南、阿莫西林/克拉维酸、氯霉素、环丙沙星、磺胺甲恶唑/甲氧苄啶和利福平抗菌药物敏感率均>90%;而对阿奇霉素耐药率为45.52%。结论阻塞性肺炎合并下呼吸道感染的病原菌以革兰阴性杆菌为主,其耐药率呈上升趋势;3、4代头孢类抗菌药物对苛养菌引起的下呼吸道感染具有很强的抗菌能力。OBJECTIVE To explore the distribution and drug resistance of fastidious bacteria caused obstructive pneumonia in patients with lower respiratory tract hospital acquired infection,so as to provide evidence for reasonable use of antibiotics to clinical treatment of pulmonary infections.METHODS Chocolate medium was used for the bacterial culture and isolation of all samples from different clinical departments.Satellitism was used for the detection of Haemophilus.Kirby-Bauer were used for the drug sensitive test to 19 kinds of antibiotics,and the results were analyzed on CLSI guideline for drug sensitive test.β-lactamase was detected by nitrocefin disk test.RESULTS The sensitively rate of was 100% to moxifloxacin,levofloxacin,imipenem,but to ampicillin/sulbactam,cefuroxime and azithromycin the antibiotic resistance rates were 93.08%,66.86% and 95.38%,respectively.The sensitivity rates of Moraxella catarrhalis were〉90%to the third and fourth generation of cephalosporins,ampicillin/sulbactam,imipenem,amoxicillin/clavulanicacid,chloramphenicol,ciprofloxacin,sulfamethylisoxazole/trimethoprim and rifampicin,but the resistance rate to azithromycin was 45.52%.CONCLUSION The obstructive pneumonia complicated by lower respiratory tract infection are mostly caused by the gram-negative bacteria,whose resistance levels to antibiotics was rising gradually.The third and fourth generation cephalosporin antibiotics have strong activity against fastidious bacteria caused lower respiratory tract infection.

关 键 词：下呼吸道感染 苛养菌 耐药性 Β-内酰胺酶 

分 类 号：R563.1[医药卫生—呼吸系统]