2011-2015年神经外科患者下呼吸道感染病原菌分布及耐药性分析  

Distribution and Antibiotic Resistance of Pathogens in Lower Respiratory Infection of Neurosurgical Patients From 2011 to 2015

作　　者：沈娟[1] 杨海燕[1] 周芸[1] 朱健铭 黄支密[1] 

机构地区：[1]解放军第98医院检验科,湖州313000 [2]杭州市余杭区中医院检验科,杭州311106

出　　处：《国外医药（抗生素分册）》2017年第1期9-13,共5页World Notes on Antibiotics

基　　金：杭州市科技发展计划基金资助项目(20140633B56)

摘　　要：目的研究神经外科患者下呼吸道感染病原菌分布规律及其耐药性,进而为临床抗菌感染经验治疗提供依据。方法收集2011—2015年神经外科住院下呼吸道感染患者的痰标本送检,采用Micro Scan Walk Away-96 plus全自动微生物分析系统及其相关配套试剂进行细菌鉴定及药敏试验。采用WHONET 5.6软件统计分离出的非重复性感染细菌种类并进行耐药性分析。结果自神经外科下呼吸道感染住院患者中共检出1880株病原菌,其中革兰阴性细菌1308株,占69.57%,占比前4位的分别为肺炎克雷伯菌(19.26%)、鲍曼不动杆菌(14.68%)、铜绿假单胞菌(13.56%)和黏质沙雷菌(5.37%);革兰阳性细菌496株,占26.38%,占比前3位的分别为金黄色葡萄球菌(10.90%)、凝固酶阴性葡萄球菌(13.62%)和肠球菌(1.01%);真菌占4.04%,以假丝酵母为主(3.88%)。肺炎克雷伯菌对氨苄西林、替卡西林耐药率较高,对替加环素、阿米卡星耐药率相对较低。鲍曼不动杆菌对加替沙星、哌拉西林/三唑巴坦等耐药率较高,对多黏菌素E较敏感。铜绿假单胞菌耐药率相对居中。黏质沙雷菌对头孢唑啉、头孢噻吩、头孢呋辛等耐药率极高,而对替卡西林/克拉维酸、阿米卡星、亚胺培南较敏感。葡萄球菌对青霉素G耐药率极高,金黄色葡萄球菌和凝固酶阴性葡萄球菌对苯唑西林的耐药率分别为46.34%、95.31%,未发现对万古霉素耐药的葡萄球菌。结论神经外科下呼吸道感染以革兰阴性菌为主,各种细菌对临床常用抗菌药物的耐药程度不同;主要病原菌的耐药率较高。Objective To investigate the distribution of pathogens and their antibiotic resistance in neurosurgical patients with lower respiratory tract infections, then provide the basis for clinical treatment with antibacterial infections. Methods Collect the respiratory infections sputum specimens in neurosurgical hospitalized patients for bacterial identification and susceptibility testing by using MicroScan WalkAway-96 plus automated microbial analysis systems and related reagents. To perform a drug resistance analysis by using WHONET 5.6 software with separated non-recurring infection bacterial species. Results A total of 1880 pathogens were detected in neurosurgical patients with lower respiratory tract infections, and Gram-negative bacteria accounting for 69.57% （1308 pathogens） in which Klebsiella pneumoniae （19.26%）, Acinetobacter baumannii （14.68%）, Pseudomonas aeruginosa （13.56%） and Serratia marcescens （5.37%）. Gram-positive bacteria accounting for 26.38% （496 pathogens） in which Staphylococcus aureus （10.90%）, coagulase-negative Staphylococci （13.62%） and Enterococci （1.01%）; Fungi accounted for 4.04%, mainly were Candida （3.88%）. The resistance rates of Klebsiellapneumoniae to ampicillin, ticarcillin is high, but to tigecycline and amikacin are relatively low. The resistance rates of Acinetobacter baumannii to gatifloxacin, piperacillin / tazobactam are high, and to polymyxin E is sensitive. Pseudomonas aeruginosa resistance rate is relatively moderate. The resistance rates ofSerratia marcescens to cefazolin, cephalothin,cefuroxime is high, while to the ticarcillin/clavulanic acid, amikacin, imipenem are relatively sensitive. The resistance rates of Staphylococcus aureus to penicillin G is very high, the resistance rate of Staphylococcus aureus and coagulase negative Staphylococci to oxacillin are 46.34%, 95.31%, respectively. No vancomycin resistant Staphylococcus was found. Conclusion Gram-negative bacteria were detected mainly in neurosurgical patients with lower res

关 键 词：神经外科 下呼吸道感染 病原菌 分布 耐药 

分 类 号：R446.5[医药卫生—诊断学]