基层医院下呼吸道感染的病原菌分布及耐药性分析

摘要

目的 了解基层医院下呼吸道感染的病原菌分布及耐药现状,帮助临床合理使用抗菌药物.方法 对2007年7月-2009年6月收治的628例下呼吸道感染患者痰培养的514株病原菌进行鉴定和药敏结果进行分析.结果 下呼吸道感染主要发生在ICU和呼吸内科.革兰阴性杆菌309株,占60.1%,依次为铜绿假单胞菌、大肠埃希氏菌、 不动杆菌;革兰阳性菌113株,占21.9%;真菌92株,占18.0%.革兰阴性杆菌对亚胺培南 、头孢哌酮/舒巴坦、阿米卡星较敏感.革兰阳性球菌耐药率相当严重,但所有菌株对万古霉素敏感.分离出产ESBLs34株,耐甲氧西林葡萄球菌(MRS)55株.结论 在下呼吸道感染中,病原菌以革兰阴性杆菌为主,混合感染占了一定的比例,应引起临床重视.耐药现象普遍存在,抗菌药物使用前应常规进行培养,合理应用抗菌药物,以延缓病原菌耐药的产生.%Objective To investigate the distribution and resistance of pathogens in Lower respiratory tract infection in substrate hospital ,and help doctors to use antibiotic reasonably.Methods Sputum culture was perfomed in 628 cases who suffered from Lower respiratory tract infection in emergency ward from Jun 2007 to Jun 2009.The results of 514 pathogens and drug senslitivity was enalyzed.Results The infection caused by Lower respiratory happend frequently in ICU and department of Respiration.There were 309 (60.1％)strains of Gram-negative bacilli ,113(21.9％ ) strains of Gram-positive bacteria and 92(18.0％ ) strains of fungi.The most important Gram-negative pathogens were Pseudomonas aeruginosa, Escherichia coli ,Acinetobacter.Strains of Gram-negative bacteria were susceptible to imipenem cefoperzone/sulbactam and amikacin.Gram-positive cocci be showed very serious drugresistance ,but all of them were susceptive to vancomycin.34 strains of ESBLs and 55 strains of MRS producing bacteria were detected.Conclusion Gram-negative are the main pathogens in Lower respiratory tract infection.We must pay attention to mixed infection which occupies certain ratio.Drug resistance of the pathogenic bacteria is common.Routine sputum culture before using of antibiotics should be taken.Rational use of antibiotics is important for the containment of bacterial resistance.