社区获得性肺炎患者分离菌耐药监测报告  

Surveillance of isolated bacterial resistance in 1,195 patients with community-acquired pneumonia

作　　者：陈玲[1] 杨传松[1] 李佳 张琴 肖金[1] 赵兴丽[1] Chen Ling;Yang Chuansong;Li Jia;Zhang Qin;Xiao Jin;Zhao Xingli(Jiangyou People's Hospital,Jiangyou,Sichuan 621700,China;No903 Hospital of Jiangyou,Jiangyou,Sichuan 621700, China;Jiangyou No2 People's Hospital,Jiangyou,Sichuan 621700,China)

机构地区：[1]江油市人民医院,四川江油621700 [2]江油市九0三医院,四川江油621700 [3]江油市第二人民医院,四川江油621700

出　　处：《医药前沿》2019年第2期23-25,共3页Journal of Frontiers of Medicine

摘　　要：目的:调查江油地区社区获得性呼吸道感染患者分离主要细菌的耐药性,为本地区呼吸道感染治疗提供依据.方法:收集2015年1月-2016年12月江油地区社区获得性肺炎患者首次标本分离的1195例菌株,其中流感嗜血杆菌438株,肺炎链球菌365株,肺炎克雷伯菌143株,金黄色葡萄球菌125株,卡他,莫拉菌116株,A群链球菌8株;用微量肉汤稀释法测定常规抗菌药物的MIC值;采用WHONET-5.6软件统计与分析菌株对受试抗菌药物的敏感度.结果:江油地区社区获得性呼吸道感染,在纳入分析的呼吸道常见六种菌中,流感嗜血杆菌占36.7%,肺炎链球菌占30.5%,肺炎克雷伯菌占12.0%,金黄色葡萄球菌占10.5%,卡他莫拉菌占9.7%等.肺炎链球菌和A群链球菌对青霉素类、头孢菌素类、喹诺酮类均高度敏感(>95%),未检出对万古霉素、利奈唑胺、喹奴普汀/达福普汀耐药菌株,PRSP(耐青霉素肺炎链球菌)分离率2.7%;流感嗜血杆菌和卡他莫拉菌对测试的12种抗生素,未发现对三代头孢菌素、阿莫西林/克拉维酸、氧氟沙星耐药菌株,但卡他莫拉菌比流感嗜血杆菌更耐药,β-内酰胺酶实验阳性率也更高,前者为31.0%(36/116)、后者为21.9%(95/438);几乎所有(99.3%)受试肺炎克雷伯菌对亚胺培南及美罗培南显示敏感,在治疗肺炎克雷伯菌选择抗生素上,第三代头孢菌素如头孢噻肟、头孢曲松、头孢他啶敏感率高于第一、二代头孢菌素,但是不及喹诺酮类敏感如环丙沙星(89.5%)、左氧氟沙星(94.4%)敏感;125株金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌(MRSA)检出率为16%(20/125),对头孢菌素、环丙沙星、左氧氟沙星、阿莫西林/克拉维酸、氨苄西林/舒巴坦、复方新诺明、庆大霉素、利福平、四环素等抗生素敏感率均超过80%.结论:引起本地区CAP(不合非典型肺炎和病毒性肺炎)以细菌为流感嗜血杆菌、肺炎链球菌为主,其次为肺炎克雷伯菌、金黄色Objective To investigate the drug resistance of main bacteria isolated from community acquired respiratoiy tract infection patients in jiangyou area,and to provide basis for the treatment of respiratory tract infection in this area Methods Choose from January 2015 to December 2016,1195 strains isolated for the first time were collected,and MIC values of routine antibiotics were determined by microbroth dilution.Results No drug-resistant strains of cephalosporin,amoxicillin/clavulanic acid and ofloxacin were found in the third generation of cephalosporin.The sensitivity of the third generation cephalosporins was higher than that of the first and second generation cephalosporins, but not as sensitive as that of quinolones.Condusion Amoxicillin clavulanic acid and the third generation cephalosporin can be selected for the initial diagnosis of CAP in this regionSevere CAP can be treated with azithromycin,espiratory fluoroquinolones and other broad-spectrum antibiotics.

关 键 词：社区获得性肺炎 肺炎链球菌 流感嗜血杆菌 耐药监测 精准治疗 

分 类 号：R563.1[医药卫生—呼吸系统]