主动痰与被动痰标本中病原菌的分布及药敏特点

摘要

目的 比较主动痰标本与被动痰标本中菌群分布的差异及其药敏特点,以指导临床区别性经验用药.方法 收集2015年1~6月期间在我院留取的980份培养阳性的合格痰标本,按留取方式分为主动痰标本500份,被动痰标本480份;对各组内菌种分布特点及组间药敏结果 进行统计分析.结果主动痰标本和被动痰标本来源不同,前者主要来源为呼吸科(48.6%)和急诊病房(24.8%),后者主要来源于脑病中心(25.6%)和ICU病房(24.6%);主动痰标本和被动痰标本分离的致病菌种类也不同,主动痰中最常见的致病菌是肺炎克雷伯菌(34.0%),而被动痰标本中最常见的是铜绿假单胞菌(32.7%);两者所分离出的细菌的药敏结果也存在明显不同,被动痰标本中的细菌除了铜绿假单胞菌外,其余细菌对常用抗生素的耐药率均明显高于主动痰标本中分离出来的同种细菌,差异均有显著统计学意义(P<0.01).结论 不同留取方式下的痰标本分离出的常见致病菌存在差异,这是由患者不同的临床病情所决定的,临床微生物实验室进行致病菌菌株和药敏统计时应充分考虑到留取方式的差异,进一步细化分类,而临床医生应根据患者不同的病情和留取方式选择不同的经验性用药.%Objective To compare the difference of bacterial distribution and drug sensitivity characteristics in active and passive sputum specimens, and providing the evidence to guide the clinical individualistic medication. Methods A total of 980 positive qualified sputum samples in our hospital from January 2015 to June 2015 were collect-ed. According to the method of retention, they were divided into two groups:active sputum specimen group (n=500) and passive sputum specimen group (n=480). The distribution characteristics of bacteria and the results of drug sensitivity be-tween two groups were statistically analyzed. Results The active sputum samples were different from those of passive sputum samples in source. The former mainly came from Department of Respiration (48.6%) and Emergency Ward (24.8%), but the latter mainly came from Encephalopathy Center (25.6%) and ICU ward (24.6%). The pathogenic bacte-ria isolated from the active sputum samples and the passive sputum samples were different, and the most common pathogen in active sputum was Klebsiella pneumonia (34.0%), while Pseudomonas aeruginosa (32.7%) was the most common pathogen in passive sputum. The drug sensitivity results were also significantly different between the two sam-ples. The resistance rates of other bacteria to common antibiotics in passive sputum were significantly higher than those isolated from active sputum samples (P<0.01). Conclusion The common pathogens isolated from the sputum samples under different methods of retention were different, which is decided by the patient's different clinical condi-tions. The clinical laboratory workers should give full consideration to the specimens from the different retention mode and refine the further classification, and clinicians should select antibiotics individually according to patient's condition and retention mode.