下呼吸道院内感染复数菌的病原菌分布及耐药性分析  

Pathogen distribution and antibiotic resistance of plural bacteria nosocomial infection of lower respiratory tract

作　　者：周建甫 

机构地区：[1]三江县人民医院检验科,广西三江545500

出　　处：《华夏医学》2017年第4期50-54,共5页Acta Medicinae Sinica

摘　　要：目的:分析下呼吸道患者复数菌感染的细菌种类及耐药情况,以指导临床合理选用抗生素。方法:回顾性调查分析2 205例下呼吸道感染患者痰培养及药敏结果。结果:2 205例下呼吸道感染者,痰培养共检出菌株2 606株,以革兰阴性杆菌为主(70.0%),其次为革兰阳性球菌(19.3%)和真菌(10.7%)。检出复数菌感染401例,占18.2%,其中2种细菌混合感染388例,占96.8%,3种细菌混合感染13例,占3.2%。以肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌及大肠埃希菌为多见,139例合并真菌感染,药敏试验显示,革兰阴性杆菌对亚胺培南、美罗培南最敏感;革兰阳性球菌对万古霉素最为敏感;真菌对5-氟胞嘧啶和两性霉素B较敏感。结论:革兰阴性杆菌是下呼吸道感染的主要病原菌,引起复数菌感染的细菌多重耐药严重,临床应根据药物敏感试验针对性用药,严格消毒隔离制度,以降低复数菌感染。Objective： To analyze bacteria species and drug resistance of plural bacteria infection of lower respiratory tract patients,so as to guide clinical rational use of antibiotics. Methods： The results of bacterial cultures of sputum samples and drug sensitivity tests of 2,205 patients with lower respiratory tract infections were retrospectively analyzed. Results： Totally 2,606 strains of pathogens were isolated from 2,206 patients with lower respiratory tract infections. Gram-negative bacteria was the dominant pathogen（ 70.0%）,followed by Gram-positive cocci（ 19.3%） and fungi（ 10.7%）. 401 cases of plural bacteria infection were detected,accounting for 18. 2%; of which,388 cases were mix-infected by two types of bacteria,accounting for 96. 8%; 13 cases were infected by 3 mixed bacteria,accounting for 3. 2%.Klebsiella pneumoniae,pseudomonas aeruginosa,acinetobacter baumannii and escherichia coli were more common infected bacteria,139 cases were combined fungal infection. Susceptibility test showed that gramnegative bacilli was most sensitive to imipenem and meropenem; gram-positive cocci was most sensitive to vancomycin; and fungi was more sensitive to 5-fluorocytosine and amphotericin B. Conclusion： Gramnegative bacteria is the main pathogens of lower respiratory tract infection. Those cause plural bacteria infection will often show serious drug resistance. Therefore,targeted medication should be based on clinical drug sensitivity test,strict disinfection and isolation system to reduce the plural bacterial infections.

关 键 词：下呼吸道感染 复数菌 耐药性 

分 类 号：R56[医药卫生—呼吸系统] R96[医药卫生—内科学]