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目的分析南京市江宁医院下呼吸道感染门诊及住院患者痰样本病原体分布情况和耐药特点,为临床进一步合理用药提供可靠依据。方法收集2011-2015年南京市江宁医院门诊及住院下呼吸道感染患者痰样本,常规方法进行病原体分离,采用Vitek2-Compact全自动细菌鉴定及药敏分析系统对培养得到的纯培养物进行细菌鉴定和药敏试验,对系统不能进行药敏试验的药物采用纸片扩散法(K-B法),真菌药敏试验采用ATB FUGUNS 3试条(微量稀释法)进行。结果从2011-2015年的13 147例下呼吸道感染门诊及住院患者的痰样本中共分离出病原体4 791株,阳性检出率为36.44%。其中革兰阴性杆菌占71.34%,排列前4位的分别为肺炎克雷伯菌(19.70%)、铜绿假单胞菌(15.26%)、鲍曼不动杆菌(12.04%)和大肠埃希菌(10.17%);革兰阳性球菌占17.83%,主要为金黄色葡萄球菌(7.43%)、肠球菌(6.45%)和肺炎链球菌(3.17%);真菌占10.83%,主要为白假丝酵母菌(4.26%)、热带假丝酵母菌(3.32%)和光滑假丝酵母菌(2.50%)。药敏试验结果显示,5年间肺炎克雷伯菌对美罗培南和亚胺培南耐药率最低,分别为0%和0.21%,其次为对头孢哌酮/舒巴坦和哌拉西林/他唑巴坦的耐药率,分别为4.24%和4.87%;铜绿假单胞菌对阿米卡星、头孢吡肟、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦的耐药率较低,分别为9.17%,14.09%、12.72%和8.34%,未检出对多黏菌素B耐药株;鲍曼不动杆菌对米诺环素和头孢哌酮/舒巴坦的耐药率较低,分别为12.13%和13.86%;未检出对美罗培南和亚胺培南耐药的大肠埃希菌,对头孢哌酮/舒巴坦和哌拉西林/他唑巴坦的耐药率较低,分别为4.72%和6.78%;未检出对利奈唑胺、万古霉素和替考拉宁耐药的金黄色葡萄球和肠球菌,未检出对青霉素、利奈唑胺和万古霉素耐药的肺炎链球菌;未检出对氟胞嘧啶和两性霉素B耐药的念珠菌属。结论下呼吸道感染病原体种类多,耐药情况比较严重,临床应合理使用抗菌药物,避免耐多药菌株的出现。
Objective To analyze the distribution of pathogens and the drug resistance characteristics of sputum samples of outpatients and inpatients with lower respiratory tract infection in Jiangning Hospital of Nanjing, and to provide a reliable basis for further rational drug use in clinic. Methods The sputum samples from outpatients and inpatients with lower respiratory tract infection in Jiangning Hospital of Nanjing City from 2011 to 2015 were collected and the pathogens were isolated by routine methods. The pure cultures were identified by Vitek2-Compact and antimicrobial susceptibility analysis system Drug susceptibility testing, the system can not be drug susceptibility testing drugs using disk diffusion method (KB method), fungal susceptibility testing using ATB FUGUNS 3 test strips (micro-dilution method). Results A total of 4 791 pathogens were isolated from sputum samples from 13 147 outpatients and inpatients with lower respiratory tract infections in 2011-2015. The positive rate was 36.44%. Among them, Gram-negative bacilli accounted for 71.34%, and the top 4 were Klebsiella pneumoniae (19.70%), Pseudomonas aeruginosa (15.26%), Acinetobacter baumannii (12.04%) and Escherichia coli (10.17%); Gram-positive cocci accounted for 17.83%, mainly Staphylococcus aureus (7.43%), Enterococcus (6.45%) and Streptococcus pneumoniae (3.17%); fungi accounted for 10.83%, mainly Candida albicans (4.26%), Candida tropicalis (3.32%) and Candida glabrata (2.50%). Susceptibility test results showed that Klebsiella pneumoniae had the lowest rates of resistance to meropenem and imipenem for 5 years, 0% and 0.21% respectively, followed by cefoperazone / sulbactam and piperacillin / Resistant rates to zolbactam were 4.24% and 4.87%, respectively; resistance of Pseudomonas aeruginosa to amikacin, cefepime, piperacillin / tazobactam and cefoperazone / sulbactam The rate was lower, which was 9.17%, 14.09%, 12.72% and 8.34%, respectively. No antibiotic resistant strains to polymyxin B were detected. Acinetobacter baumannii had no effect on minocycline and cefoperazone / sulbactam Resistant rate was lower, which was 12.13% and 13.86% respectively. No Escherichia coli strains resistant to meropenem and imipenem were detected for cefoperazone / sulbactam and piperacillin / tazobactam Were 4.72% and 6.78% respectively; no detection of linea and enterococci resistant to linezolid, vancomycin and teicoplanin; no detection of penicillin, linezolid Amines and vancomycin-resistant Streptococcus pneumoniae; Candida species resistant to flucytosine and amphotericin B were not detected. Conclusions There are many kinds of pathogens in lower respiratory tract infection and their drug resistance is rather serious. Antibiotics should be used rationally to avoid the emergence of multidrug-resistant strains.