胸外科胸腔感染患者病原菌特点及耐药性分析  

Analysis of pathogenic bacteria characteristics and drug resistance in patients with thoracic cavity infection inthoracic surgery

作　　者：王雪[1] 赵天增[1] 乔飞[1] WANG Xue;ZHAO Tianzeng;QIAO Fei(The First Affiliated Hospital of Nanyang Medical College Nanyang 473000,Henan,China)

机构地区：[1]南阳医学高等专科学校第一附属医院,河南南阳473000

出　　处：《中国病原生物学杂志》2024年第10期1206-1210,共5页Journal of Pathogen Biology

摘　　要：目的 探讨胸外科胸腔感染患者病原菌分布特点及耐药性情况,以为临床合理用药提供参考依据。方法 选取157例胸腔感染患者作为研究对象,采集患者胸腔胸水标本,培养后菌种鉴定,分析主要病原菌的耐药性。检测所有患者血清降钙素原水平及急性生理学及慢性健康状况评分系统Ⅱ评分。对比不同分组患者病原菌分布特点、耐药性及血清PCT水平及APACHEⅡ评分。结果 157例胸腔感染患者中,70例为重症感染(44.59%,70/157),87例为非重症感染(55.41%,87/157)。共检出病原菌157株,包括78株革兰阴性菌,76株革兰阳性菌,3株真菌。革兰阴性菌主要包括铜绿假单胞菌(24.20%,38/157)与肺炎克雷伯菌(8.28%,13/157),革兰阳性菌主要包括金黄色葡萄球菌(25.48%,40/157)与表皮葡萄球菌14株(8.92%,14/157)。70例重症患者检出病原菌中,革兰阴性菌、革兰阳性菌、真菌分别占64.29%(45/70)、32.86%(23/70)、2.85%(2/70);87例非重症患者分别占37.93%(33/87)、60.92%(53/87)、1.15%(1/87);重症患者革兰阴性菌占比高于非重症患者,革兰阳性菌占比低于非重症患者(P<0.05),真菌占比差异无统计学意义(P>0.05)。铜绿假单胞菌对左氧氟沙星、庆大霉素、四环素的耐药率较高,对亚胺培南、阿米卡星的耐药率较低,重症患者耐药率均高于非重症感染患者。金黄色葡萄球菌对青霉素、红霉素、左氧氟沙星、庆大霉素的耐药率较高,未产生对万古霉素、利奈唑胺的耐药株,重症患者耐药率均高于非重症患者。重症患者血清PCT水平为(67.63±11.86)μg/L,非重症患者血清为(17.96±11.86)μg/L,重症患者APACHEⅡ评分为(27.79±7.00)分,非重症患者APACHEⅡ评分为(4.99±2.52)分,两组血清PCT水平、APACHEⅡ评分差异有统计学意义(P<0.05)。Pearson相关性分析显示患者的血清PCT水平与APACHEⅡ评分呈正相关。结论 胸外科胸腔感染患者中,重症患者病原菌主要为革兰阴性菌,非�Objective The distribution characteristics and drug resistance of pathogens in thoracic surgery patients with thoracic cavity infection was analyzed,in order to provide reference for rational drug use in clinical practice.Methods 157 patients with thoracic cavity infection were selected as the research subjects.Thoracic pleural effusion specimens of the patients were collected.After culturing,the bacterial species were identified,and the drug resistance of the main pathogenic bacteria was analyzed.The serum procalcitonin levels and acute physiology and chronic health status scoring system II scores of all patients were detected.The distribution characteristics,drug resistance,serum PCT levels,and APACHE II scores of pathogenic bacteria were compared among patients in different groups.ResultsAmong 157 patients with thoracic infections,70 were severe infections(44.59%,70/157)and 87 were non severe infections(55.41%,87/157).A total of 157 pathogenic bacteria were detected,including 78 Gram negative bacteria,76 Gram positive bacteria,and 3 fungi.Gram negative bacteria mainly included Pseudomonas aeruginosa(24.20%,38/157)and Klebsiella pneumoniae(8.28%,13/157),while Gram positive bacteria mainly included Staphylococcus aureus(25.48%,40/157)and 14 strains of S.epidermidis(8.92%,14/157).Among the pathogenic bacteria detected in 70 severe patients,Gram-negative bacteria,Gram-positive bacteria and fungi accounted for 64.29%(45/70),32.86%(23/70)and 2.85%(2/70)respectively;in 87 non-severe patients,they accounted for 37.93%(33/87),60.92%(53/87)and 1.15%(1/87)respectively.The proportion of Gram-negative bacteria in severe patients was higher than that in non-severe patients,and the proportion of Gram-positive bacteria was lower than that in non-severe patients(P<0.05).There was no statistically significant difference in the proportion of fungi(P>0.05).P.aeruginosa had a higher resistance rate to levofloxacin,gentamicin,and tetracycline,but a lower resistance rate to imipenem and amikacin.The resistance rate of severe patient

关 键 词：胸腔感染 病原菌 耐药性 降钙素原 

分 类 号：R446.5[医药卫生—诊断学]