试论下呼吸道感染病原菌特点及耐药性

摘要

目的：为临床合理选择抗菌药物、加强疗效提供参考依据。方法：收集2013年1月-2014年12月青海大学附属医院呼吸科下呼吸道感染患者痰液及支气管肺泡灌洗液标本进行送检，对普通病房患者和ICU病房患者病原菌分布情况进行分析，统计所分离菌株的分布特点及耐药性特点。结果：本次调查以革兰阴性杆菌最为多见，其次为真菌，革兰阳性杆菌所占比例最少。在革兰阴性杆菌中，检出率最高的病原菌排前四位的分别是铜绿假单胞菌、肺炎克雷伯菌、鲍曼氏不动杆菌和大肠埃希菌。革兰阳性杆菌主要以金黄色葡萄球菌为主。革兰阴性杆菌和革兰阳性杆菌均普遍出现了多重耐药菌株。真菌主要以白假丝酵母菌为主。结论：下呼吸道感染主要致病菌是革兰阴性菌，其次是真菌，不同菌种对抗菌药物的耐药性不同，在临床上，应合理选择靶向抗感染治疗药物。%OBJECTIVE To provide some references for the rational choice of antimicrobial agents and enhancement of curative effect for clinical. METHODS Collect Department of Respiratory Medicine lower respiratory infection patients’ sputum and bronchoalveolar lavage fluid samples inspection in January 2013 -December 2014,then analyze pathogen distribution of common ward patients and ICU patients,and then conduct statistical distribution of the characteristics of isolated strains and drug resistance. RESULTS The survey shows the most common germ is gram negative bacillus, followed by the fungus, and the proportion of gram positive bacteria is the least. As for the gram-negative bacilli,the highest detection rate of pathogen row of the top four are respectively pseudomonas aeruginosa, klebsiella pneumoniae, bowman's acinetobacter and escherichia coli. Gram-positive bacteria are mainly composed of staphylococcus aureus;Gram-negative bacilli and gram-positive bacilli generally generate multiple drug-resistant strains, and Candida albicans is the main fungus. CONCLUSION The main pathogenic bacteria of the lower respiratory tract infection is gram-negative bacteria, followed by the fungus; In clinic,due to difference of antimicrobial drug resistance,different strains should choose reasonably targeted anti-infection drugs.