痰培养致病菌的分布及药敏分析研究  

Study on the distribution and drug sensitivity analysis of pathogenic bacteria in sputum culture

作　　者：王兴阳 张乐 胡静仪[1] WANG Xing-yang;ZHANG Le;HU Jing-yi(Department of Clinical Laboratory,Tianjin Key Laboratory of Cerebrovascular Disease and Neural Degeneration,Tianjin Huanhu Hospital,Tianjin 300350,China)

机构地区：[1]天津市环湖医院检验科,天津市脑血管病和神经变性重点实验室,天津300350

出　　处：《中国城乡企业卫生》2023年第12期26-30,共5页Chinese Journal of Urban and Rural Enterprise Hygiene

摘　　要：目的了解痰培养中致病菌的分布及药敏特点,指导临床合理有效控制感染。方法收集天津市环湖医院2018—2020年的痰标本,按照《全国临床检验操作规程》分离、培养、鉴定病原菌,并采用VITEK 2 Compact进行药敏分析。结果2018—2020年痰培养中,共分离出致病菌7027株。排名前5的依次是肺炎克雷伯菌2662株(37.9%)、鲍曼不动杆菌1200株(17.1%)、铜绿假单胞菌862株(12.3%)、金黄色葡萄球菌410株(5.8%)、大肠埃希菌354株(5.1%)。常见多重耐药菌中,肺炎克雷伯菌呈上升趋势,铜绿假单胞菌和大肠埃希菌呈下降趋势,差异均有统计学意义(P<0.05)。根据药敏结果统计,痰标本中肺炎克雷伯菌对碳青霉烯类药物的敏感性为81.4%~94.2%,铜绿假单胞菌对阿米卡星的敏感性为91.9%。严重的大肠杆菌感染可采用替加环素与碳青霉烯类药物联合治疗,严重的金黄色葡萄球菌感染首选万古霉素。结论细菌耐药问题严重,对细菌耐药性的监测与分析,可以掌握细菌的耐药趋势,从而指导临床更准确地用药。Objective To understand the distribution and drug sensitivity characteristics of pathogenic bacteria in sputum culture,and guide clinical rational and effective control of infection.Methods Sputum samples from Tianjin Huanhu Hospital from 2018 to 2020 were collected,according to the National Clinical Laboratory Operating Regulations,pathogenic bacteria were isolated,cultured and identified,and drug sensitivity analysis was conducted using VITEK 2 Compact.Results From 2018 to 2020 in sputum culture,7027 strains of pathogenic bacteria were isolated.The top five were Klebsiella pneumoniae 2662 strains(37.9%),Acinetobacter baumanni 1200 strains(17.1%),Pseudomonas aeruginosa 862 strains(12.3%),Staphylococcus aureus 410 strains(5.8%)and Escherichia coli 354 strains(5.1%).Among the common multidrug-resistant bacteria,Klebsiella pneumoniae showed an upward trend,Pseudomonas aeruginosa and Escherichia coli showed a downward trend,and the differences were statistically significant(P<0.05).According to the statistics of drug sensitivity,the sensitivity of Klebsiella pneumoniae to carbapenems in sputum samples was 81.4%-94.2%,and the sensitivity of Pseudomonas aeruginosa to amikacin was 91.9%.Severe Escherichia coli infection could be treated with the combination of tigecycline and carbapenems.Vancomycin was the first choice for severe Staphylococcus aureus infection.Conclusion The problem of bacterial drug resistance was serious,monitoring and analyzing bacterial drug resistance could grasp the trend of bacterial drug resistance,so as to guide clinical medication more accurately.

关 键 词：细菌分布 耐药性 痰培养 

分 类 号：R978.1[医药卫生—药品] R446.5[医药卫生—药学]